Provider Demographics
NPI:1326325176
Name:GAMBOA, JOSE ANTONIO
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:GAMBOA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9337
Mailing Address - Country:US
Mailing Address - Phone:956-664-1272
Mailing Address - Fax:956-664-2151
Practice Address - Street 1:702 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-9337
Practice Address - Country:US
Practice Address - Phone:956-664-1272
Practice Address - Fax:956-664-2151
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3920880001Medicare NSC