Provider Demographics
NPI:1265192876
Name:MBAYO, GBAMA
Entity type:Individual
Prefix:
First Name:GBAMA
Middle Name:
Last Name:MBAYO
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 1:5880 3RD ST APT 437
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-3172
Mailing Address - Country:US
Mailing Address - Phone:518-866-3283
Mailing Address - Fax:
Practice Address - Street 1:5880 3RD ST APT 437
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-3172
Practice Address - Country:US
Practice Address - Phone:518-866-3283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95072066163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical