Healthcare Provider Details

I. General information

NPI: 1992152037
Provider Name (Legal Business Name): CINDY GAMBOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND SPRINGS AVE STE 303
BEAUMONT CA
92223-3170
US

IV. Provider business mailing address

FILE # 54701
LOS ANGELES CA
90074-4701
US

V. Phone/Fax

Practice location:
  • Phone: 951-846-2611
  • Fax:
Mailing address:
  • Phone: 909-558-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number815655
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95006276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: