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General NPI Number Information
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NPI Number | 1548916398
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Entity Type | Organization
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Legal Business Name | NORVA A. GAMBOA DDS., INC.
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 15708 POMERADO RD STE N101
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City | POWAY
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State | CA
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Zip | 92064-2066
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Country | US
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Telephone | 858-524-1257
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Fax | 858-524-1259
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Provider Business Mailing Address
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Address Line | 15708 POMERADO RD STE N101
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City | POWAY
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State | CA
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Zip | 92064-2066
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Country | US
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Telephone | 858-524-1257
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Fax | 858-524-1259
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Authorized Official
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Title or Position | PRESIDENT
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Name | NORVA GAMBOA
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Credential | DDS
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Telephone | 858-524-1257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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