Provider Demographics
NPI:1033418371
Name:GAMBOA, SEAN ANDREW
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ANDREW
Last Name:GAMBOA
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 1:1385 N JOHNSON AVE
Mailing Address - Street 2:111
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1660
Mailing Address - Country:US
Mailing Address - Phone:619-441-2493
Mailing Address - Fax:
Practice Address - Street 1:1385 N JOHNSON AVE
Practice Address - Street 2:111
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1660
Practice Address - Country:US
Practice Address - Phone:619-441-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)