Healthcare Provider Details

I. General information

NPI: 1215472006
Provider Name (Legal Business Name): AMBER L GAMBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S HALCYON RD
ARROYO GRANDE CA
93420-3116
US

IV. Provider business mailing address

136 S HALCYON RD
ARROYO GRANDE CA
93420-3116
US

V. Phone/Fax

Practice location:
  • Phone: 805-835-9406
  • Fax:
Mailing address:
  • Phone: 805-835-9406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number91890
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118208
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC11761
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5798C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: