Provider Demographics
NPI:1801677885
Name:GAMBOA, ANGELA (OMT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 W SPRUCE ST # 1463
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2553
Mailing Address - Country:US
Mailing Address - Phone:877-662-1252
Mailing Address - Fax:
Practice Address - Street 1:807 W LOWRY LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-4711
Practice Address - Country:US
Practice Address - Phone:813-368-2163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH18124174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist