Provider Demographics
NPI:1801401963
Name:GAMBINO, MANUEL (CI42710524)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:GAMBINO
Suffix:
Gender:M
Credentials:CI42710524
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:
Other - Last Name:GAMBINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 EAST HARRY BRIDGES BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744
Mailing Address - Country:US
Mailing Address - Phone:310-549-8383
Mailing Address - Fax:310-835-1202
Practice Address - Street 1:117 EAST HARRY BRIDGES BOULEVARD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744
Practice Address - Country:US
Practice Address - Phone:310-549-8383
Practice Address - Fax:310-835-1202
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist