Provider Demographics
NPI:1225166648
Name:GAMBINO, KIMBERLY (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 SANTO RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-1196
Mailing Address - Country:US
Mailing Address - Phone:858-541-0505
Mailing Address - Fax:
Practice Address - Street 1:6030 SANTO RD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-1196
Practice Address - Country:US
Practice Address - Phone:858-541-0505
Practice Address - Fax:858-541-0527
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1712645OtherMT STATE BCBS