Provider Demographics
NPI:1902400104
Name:WEBBER-GAMBOA, ASHLEY (CPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WEBBER-GAMBOA
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S JONES BLVD UNIT 7907
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2623
Mailing Address - Country:US
Mailing Address - Phone:725-243-4242
Mailing Address - Fax:702-675-9186
Practice Address - Street 1:1608 STARRIDGE WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-1175
Practice Address - Country:US
Practice Address - Phone:702-273-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV55189-AL-0374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician