Provider Demographics
NPI:1366318354
Name:GOMBEH, GILLO
Entity type:Individual
Prefix:
First Name:GILLO
Middle Name:
Last Name:GOMBEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6148 EDSALL RD APT 304
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-5868
Mailing Address - Country:US
Mailing Address - Phone:732-439-1170
Mailing Address - Fax:
Practice Address - Street 1:6148 EDSALL RD APT 304
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-5868
Practice Address - Country:US
Practice Address - Phone:732-439-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024195064163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health