Provider Demographics
NPI:1437149440
Name:GOYANKO-BORROMEO, IMELDA D (MD)
Entity Type:Individual
Prefix:DR
First Name:IMELDA
Middle Name:D
Last Name:GOYANKO-BORROMEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IMELDA
Other - Middle Name:GOYANKO
Other - Last Name:BORROMEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10419 12TH ST E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98372-1812
Mailing Address - Country:US
Mailing Address - Phone:509-251-3185
Mailing Address - Fax:
Practice Address - Street 1:10419 12TH ST E
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98372-1812
Practice Address - Country:US
Practice Address - Phone:509-251-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000353172084P0800X
CA1767622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8251415Medicaid
WA71895Medicare UPIN
WA8251415Medicaid