Provider Demographics
NPI:1225376379
Name:GAMBOA, NORVA ANTONIO (DDS)
Entity Type:Individual
Prefix:MRS
First Name:NORVA
Middle Name:ANTONIO
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9011 TICKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2842
Mailing Address - Country:US
Mailing Address - Phone:858-382-0842
Mailing Address - Fax:619-269-4249
Practice Address - Street 1:15708 POMERADO RD STE N101
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2066
Practice Address - Country:US
Practice Address - Phone:858-524-1257
Practice Address - Fax:858-524-1259
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS61536122300000X
CA61536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist