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General NPI Number Information
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NPI Number | 1518256627
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Entity Type | Individual
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Provider Name | JOHN DIMAYA SAMBUENO PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 439 PAUL RD
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City | ROCHESTER
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State | NY
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Zip | 14624-4721
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Country | US
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Telephone | 585-247-6858
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Fax | 585-247-2014
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Provider Business Mailing Address
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Address Line | 38 RUE DE LA COMPTINE
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City | GATINEAU
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State | QUEBEC
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Zip | J8Z2R9
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Country | CA
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Telephone | 819-503-1285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810003486
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License Number State | VA
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