Provider Demographics
NPI:1265591655
Name:GABUYA, RODUAR PONCE (PSYD)
Entity type:Individual
Prefix:DR
First Name:RODUAR
Middle Name:PONCE
Last Name:GABUYA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 E COLORADO BLVD FL 8
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2044
Mailing Address - Country:US
Mailing Address - Phone:626-229-3821
Mailing Address - Fax:
Practice Address - Street 1:532 E COLORADO BLVD
Practice Address - Street 2:8TH FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2044
Practice Address - Country:US
Practice Address - Phone:626-229-3821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical