Provider Demographics
NPI:1265190169
Name:GAMBOA-ESPINO, JOYCE (RDHAP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:GAMBOA-ESPINO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2006
Mailing Address - Country:US
Mailing Address - Phone:818-216-6896
Mailing Address - Fax:
Practice Address - Street 1:1479 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2006
Practice Address - Country:US
Practice Address - Phone:818-216-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA875124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist