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General NPI Number Information
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NPI Number | 1265508980
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Entity Type | Individual
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Provider Name | EDGAR GAMBOA MD
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Gender | Male
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 243 GREEN VALLEY RD STE. D
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City | FREEDOM
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State | CA
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Zip | 95019-3133
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Country | US
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Telephone | 831-724-7874
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Fax | 831-724-4339
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Provider Business Mailing Address
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Address Line | 576 HARTNELL ST STE 200
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City | MONTEREY
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State | CA
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Zip | 93940-2834
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Country | US
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Telephone | 831-324-0176
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C41857
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License Number State | CA
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