Provider Demographics
NPI:1922263128
Name:GAMBINO, ELISA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:LYNN
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21081 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1703
Mailing Address - Country:US
Mailing Address - Phone:310-533-6600
Mailing Address - Fax:310-787-9035
Practice Address - Street 1:21081 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1703
Practice Address - Country:US
Practice Address - Phone:310-533-6600
Practice Address - Fax:310-787-9035
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical