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General NPI Number Information
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NPI Number | 1578170338
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Entity Type | Individual
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Provider Name | APRIEL EVE CELESTE GAMBOA
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Gender | Female
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 31764 CASINO DR STE 200
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-2312
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Country | US
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Telephone | 951-471-4649
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Fax |
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Provider Business Mailing Address
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Address Line | 31747 FILLE DR
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City | WINCHESTER
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State | CA
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Zip | 92596-9118
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Country | US
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Telephone |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R1564950624
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License Number State | CA
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