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General NPI Number Information
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NPI Number | 1356961122
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Entity Type | Individual
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Provider Name | YENNIER PEILLON GAMBOA DNP, APRN, NP-C
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Gender | Male
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 01/21/2024
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Provider Practice Location Address
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Address Line | 1912 S 1ST ST
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City | GARLAND
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State | TX
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Zip | 75040-8409
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Country | US
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Telephone | 469-996-5502
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Fax |
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Provider Business Mailing Address
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Address Line | 14615 BREYANA PARK LN
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City | HUMBLE
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State | TX
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Zip | 77396-4799
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Country | US
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Telephone | 713-714-1245
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Fax | 832-412-1445
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP145396
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License Number State | TX
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