Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G36984 | CA |
NPI | 1205803087 |
---|---|
Provider Name | Dr. Ralph Anthony Gambardella |
First Address | Los Angeles, CA 90045-1543 |
Second Address | Los Angeles, CA 90045-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A46897 | (02) | CA |