Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | C41941 | CA |
NPI | 1487768271 |
---|---|
Provider Name | Dr. Lucie N. Gamboa |
First Address | Freedom, CA 95019-3160 |
Second Address | Freedom, CA 95019-3160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 05/07/2011 |