Provider Demographics
NPI:1245711050
Name:GATOBU, JULIET MAKENA (APRN)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:MAKENA
Last Name:GATOBU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 ROUGHRIDER DR
Mailing Address - Street 2:
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78239-2428
Mailing Address - Country:US
Mailing Address - Phone:210-657-3700
Mailing Address - Fax:210-657-3708
Practice Address - Street 1:8101 ROUGHRIDER DR
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-2428
Practice Address - Country:US
Practice Address - Phone:210-657-3700
Practice Address - Fax:210-657-3708
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5378364082363L00000X
KS78364363LG0600X
TXAP138627363LP0808X
TX64600363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health