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General NPI Number Information
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NPI Number | 1215179684
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Entity Type | Individual
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Provider Name | JESUS ARECHIGA GAMBOA FNP
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Gender | Male
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 6233 PIONEERTOWN ROAD
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City | YUCCA VALLEY
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State | CA
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Zip | 92284
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Country | US
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Telephone | 760-774-2739
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Fax |
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Provider Business Mailing Address
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Address Line | 6233 PIONEERTOWN RD
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-5300
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Country | US
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Telephone | 760-774-2739
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 18834
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License Number State | CA
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