Provider Demographics
NPI:1851110183
Name:LUMABAO, MARIJOIE C (RBT)
Entity type:Individual
Prefix:
First Name:MARIJOIE
Middle Name:C
Last Name:LUMABAO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 CORAL SEA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-1168
Mailing Address - Country:US
Mailing Address - Phone:646-301-1628
Mailing Address - Fax:
Practice Address - Street 1:3434 MIDWAY DR STE 2006
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4925
Practice Address - Country:US
Practice Address - Phone:619-255-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-24-378828106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician