Provider Demographics
NPI:1417141912
Name:GAMBOA SEJAS, DANIELA (MD)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:GAMBOA SEJAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:GAMBOA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6828 DELEON ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3437
Mailing Address - Country:US
Mailing Address - Phone:703-725-7950
Mailing Address - Fax:
Practice Address - Street 1:1173 W JOHN CARPENTER FREEWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039
Practice Address - Country:US
Practice Address - Phone:469-947-6020
Practice Address - Fax:469-947-6021
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8188207Q00000X
TX43243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM63127881Medicaid
TXP01217236OtherRAILROAD MEDICARE
TX217849301Medicaid
OK200302930 AMedicaid
TX8DS368OtherBCBS
TX217849303Medicaid
TXTXB125790Medicare PIN
TX217849301Medicaid
TX290192YPF6Medicare PIN