Provider Demographics
NPI:1982842373
Name:GAMBOA, LUZ LILIANA (DDS)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:LILIANA
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SALTON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2425
Mailing Address - Country:US
Mailing Address - Phone:949-413-5837
Mailing Address - Fax:714-545-7108
Practice Address - Street 1:1175 BAKER ST STE A4
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4139
Practice Address - Country:US
Practice Address - Phone:714-545-9990
Practice Address - Fax:714-545-7108
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist