Provider Demographics
NPI:1225172216
Name:GAMBOA, M.A.P. (MD)
Entity Type:Individual
Prefix:DR
First Name:M.A.P.
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA ALLEN
Other - Middle Name:P
Other - Last Name:GAMBOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:268 W HOSPITALITY LN
Mailing Address - Street 2:STE. 400
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0001
Mailing Address - Country:US
Mailing Address - Phone:909-382-3087
Mailing Address - Fax:909-382-3106
Practice Address - Street 1:268 W HOSPITALITY LN
Practice Address - Street 2:STE. 400
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0001
Practice Address - Country:US
Practice Address - Phone:909-382-3087
Practice Address - Fax:909-382-3106
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA343312084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry