Provider Demographics
NPI:1437370160
Name:GAMBOA LLC
Entity Type:Organization
Organization Name:GAMBOA LLC
Other - Org Name:VEGAS VALLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBOA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-478-6914
Mailing Address - Street 1:3230 E CHARLESTON BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6626
Mailing Address - Country:US
Mailing Address - Phone:702-478-6914
Mailing Address - Fax:702-478-6915
Practice Address - Street 1:3230 E CHARLESTON BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6626
Practice Address - Country:US
Practice Address - Phone:702-478-6914
Practice Address - Fax:702-478-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty