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General NPI Number Information
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NPI Number | 1336759349
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Entity Type | Individual
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Provider Name | CHRISTOPHER LEE GAMBLE
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Gender | Male
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 1990 MCCULLOCH BLVD N # D55
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5749
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Country | US
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Telephone | 928-224-2989
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Fax |
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Provider Business Mailing Address
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Address Line | 33801 VISTA GRANDE
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City | DANA POINT
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State | CA
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Zip | 92629-4523
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Country | US
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Telephone | 301-639-3822
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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