Provider Demographics
NPI:1669243572
Name:JAMMOA, GABRIELA NOELANI
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:NOELANI
Last Name:JAMMOA
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 1:1682 ANGELA RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2211
Mailing Address - Country:US
Mailing Address - Phone:248-513-1650
Mailing Address - Fax:
Practice Address - Street 1:1682 ANGELA RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-2211
Practice Address - Country:US
Practice Address - Phone:485-131-6502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program