Provider Demographics
NPI:1144563370
Name:GAMBOA, CHRISTINA T (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:T
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9357 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9752
Mailing Address - Country:US
Mailing Address - Phone:208-672-1000
Mailing Address - Fax:208-672-1010
Practice Address - Street 1:9357 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-672-1000
Practice Address - Fax:208-672-1010
Is Sole Proprietor?:No
Enumeration Date:2013-04-06
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00721082085R0001X
390200000X
IDM-141422085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program