Healthcare Provider Details

I. General information

NPI: 1407657216
Provider Name (Legal Business Name): GBC LOS BANOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W PACHECO BLVD
LOS BANOS CA
93635-4041
US

IV. Provider business mailing address

135 S CENTER ST
TURLOCK CA
95380-4507
US

V. Phone/Fax

Practice location:
  • Phone: 800-510-1365
  • Fax:
Mailing address:
  • Phone: 209-495-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. ROMENA KIRYAKOUS
Title or Position: CEO
Credential: PSYD
Phone: 209-495-7724