Provider Demographics
NPI:1740829233
Name:GAMBLE, JAMES RICHARD SR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:GAMBLE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 DELTA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-4113
Mailing Address - Country:US
Mailing Address - Phone:619-802-9993
Mailing Address - Fax:
Practice Address - Street 1:4104 DELTA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-4113
Practice Address - Country:US
Practice Address - Phone:619-802-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)