Healthcare Provider Details

I. General information

NPI: 1639727050
Provider Name (Legal Business Name): GILMER BORBO M.S., CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 22ND AVE BLDG 302
HONOLULU HI
96816-4400
US

IV. Provider business mailing address

475 22ND AVE BLDG 302
HONOLULU HI
96816-4400
US

V. Phone/Fax

Practice location:
  • Phone: 808-305-9750
  • Fax: 808-733-9154
Mailing address:
  • Phone: 808-305-9750
  • Fax: 808-733-9154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1438
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: