Provider Demographics
NPI:1972711646
Name:GAMBOA, MINETTE (PT)
Entity Type:Individual
Prefix:
First Name:MINETTE
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROSSI CIR
Mailing Address - Street 2:141
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-2362
Mailing Address - Country:US
Mailing Address - Phone:831-757-4444
Mailing Address - Fax:831-757-4419
Practice Address - Street 1:4 ROSSI CIR
Practice Address - Street 2:141
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93907-2362
Practice Address - Country:US
Practice Address - Phone:831-757-4444
Practice Address - Fax:831-757-4419
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT28485OtherLICENSE