Provider Demographics
NPI:1518256627
Name:SAMBUENO, JOHN DIMAYA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DIMAYA
Last Name:SAMBUENO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:SAMBUENO
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38 RUE DE LA COMPTINE
Mailing Address - Street 2:
Mailing Address - City:GATINEAU
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:J8Z2R9
Mailing Address - Country:CA
Mailing Address - Phone:819-503-1285
Mailing Address - Fax:
Practice Address - Street 1:439 PAUL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-4721
Practice Address - Country:US
Practice Address - Phone:585-247-6858
Practice Address - Fax:585-247-2014
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical