Provider Demographics
NPI:1407532906
Name:GUMBOC, YADZMEGAN GO
Entity Type:Individual
Prefix:
First Name:YADZMEGAN
Middle Name:GO
Last Name:GUMBOC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PIIKOI ST APT 1510
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-7200
Mailing Address - Country:US
Mailing Address - Phone:808-205-3590
Mailing Address - Fax:
Practice Address - Street 1:905 KALANIANAOLE HWY SPC 5001
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4669
Practice Address - Country:US
Practice Address - Phone:808-247-2973
Practice Address - Fax:808-427-3472
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician