Provider Demographics
NPI:1376860346
Name:TUMBAGA, GLORIA MARIE F. KIMIE (MD)
Entity Type:Individual
Prefix:MS
First Name:GLORIA MARIE F.
Middle Name:KIMIE
Last Name:TUMBAGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1901
Mailing Address - Country:US
Mailing Address - Phone:808-387-3302
Mailing Address - Fax:
Practice Address - Street 1:1294 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1901
Practice Address - Country:US
Practice Address - Phone:808-387-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121308208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program