MEDICARE: MS. GLORIA MARIE F. KIMIE TUMBAGA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A121308	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1376860346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLORIA MARIE F. KIMIE TUMBAGA MD

Provider Business Mailing Address
First Line	:	1294 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1901
Country	:	US
Telephone Number	:	808-387-3302
Fax Number	:

Provider Business Practice Location Address
First Line	:	1294 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1901
Country	:	US
Telephone Number	:	808-387-3302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	07/17/2015

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