Provider Demographics
NPI:1730317488
Name:GAMBOA, MARIA LUISA (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARIA LUISA
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 PLUM LN STE 121
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4578
Mailing Address - Country:US
Mailing Address - Phone:909-659-7095
Mailing Address - Fax:
Practice Address - Street 1:1706 PLUM LN STE 121
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4578
Practice Address - Country:US
Practice Address - Phone:909-659-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48545106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist