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General NPI Number Information
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NPI Number | 1407657216
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Entity Type | Organization
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Legal Business Name | GBC LOS BANOS LLC
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 30 W PACHECO BLVD
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City | LOS BANOS
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State | CA
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Zip | 93635-4041
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Country | US
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Telephone | 800-510-1365
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Fax |
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Provider Business Mailing Address
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Address Line | 135 S CENTER ST
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City | TURLOCK
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State | CA
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Zip | 95380-4507
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Country | US
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Telephone | 209-495-7724
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ROMENA KIRYAKOUS
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Credential | PSYD
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Telephone | 209-495-7724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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