Healthcare Provider Details

I. General information

NPI: 1376860346
Provider Name (Legal Business Name): GLORIA MARIE F. KIMIE TUMBAGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1294 E COLORADO BLVD
PASADENA CA
91106-1901
US

IV. Provider business mailing address

1294 E COLORADO BLVD
PASADENA CA
91106-1901
US

V. Phone/Fax

Practice location:
  • Phone: 808-387-3302
  • Fax:
Mailing address:
  • Phone: 808-387-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA121308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: