Provider Demographics
NPI:1720979974
Name:GBONDO, TAMBA FREDERICK
Entity type:Individual
Prefix:
First Name:TAMBA
Middle Name:FREDERICK
Last Name:GBONDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3392 MOORPARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-2231
Mailing Address - Country:US
Mailing Address - Phone:408-669-6361
Mailing Address - Fax:
Practice Address - Street 1:3392 MOORPARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-2231
Practice Address - Country:US
Practice Address - Phone:408-669-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner