Provider Demographics
NPI:1659851145
Name:GAMBOA, JOAQUINA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOAQUINA
Middle Name:MARIE
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 ALEGRE LN
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-5233
Mailing Address - Country:US
Mailing Address - Phone:361-946-1818
Mailing Address - Fax:
Practice Address - Street 1:3030 FIG ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3834
Practice Address - Country:US
Practice Address - Phone:361-888-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty