Provider Demographics
NPI:1467795179
Name:GAMBOA, SANDRA (CNA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LUDLAM DR APT 9
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4971
Mailing Address - Country:US
Mailing Address - Phone:305-721-7861
Mailing Address - Fax:786-462-4330
Practice Address - Street 1:601 LUDLAM DR APT 9
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-4971
Practice Address - Country:US
Practice Address - Phone:305-721-7861
Practice Address - Fax:786-462-4330
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNA109533376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide