Provider Demographics
NPI:1275615718
Name:GAMBOA, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6334
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92816-0334
Mailing Address - Country:US
Mailing Address - Phone:714-935-6363
Mailing Address - Fax:714-935-8112
Practice Address - Street 1:1020 S ANAHEIM BLVD STE 214
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5808
Practice Address - Country:US
Practice Address - Phone:714-935-6363
Practice Address - Fax:714-935-8112
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA452912084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry