Healthcare Provider Details

I. General information

NPI: 1588622955
Provider Name (Legal Business Name): JOHN P GAMBIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 ONEIL LN
EUREKA CA
95503-4870
US

IV. Provider business mailing address

2828 ONEIL LN
EUREKA CA
95503-4870
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-9385
  • Fax: 707-443-0258
Mailing address:
  • Phone: 707-443-9385
  • Fax: 707-443-0258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA24766
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA24766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: