Healthcare Provider Details

I. General information

NPI: 1366982225
Provider Name (Legal Business Name): AMY GAMBLE LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8850
US

IV. Provider business mailing address

1735 SANDPIPER DR
YUBA CITY CA
95993-7160
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7209
  • Fax:
Mailing address:
  • Phone: 530-933-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberPT 37329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: