Provider Demographics
NPI:1508862269
Name:GAHOL, RENATO C (MD)
Entity Type:Individual
Prefix:MR
First Name:RENATO
Middle Name:C
Last Name:GAHOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 GOV. CARLOS G. CAMACHO RD.
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-647-5413
Mailing Address - Fax:671-649-6948
Practice Address - Street 1:790 GOV. CARLOS G. CAMACHO RD.
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-647-5413
Practice Address - Fax:671-649-6948
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0540972084P0800X
GUM-14102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDJSLMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER