MEDICARE: MS. PATRICIA J GAMBOL APNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364S00000X	Clinical Nurse Specialist	CNS2042	CA

General Provider Information

NPI Number	:	1144201138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA J GAMBOL APNG

Provider Business Mailing Address
First Line	:	1561 NORTHWOOD RD
Second Line	:	APT 272A
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-3492
Country	:	US
Telephone Number	:	562-342-9356
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E 28TH ST
Second Line	:	SUITE 412
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2759
Country	:	US
Telephone Number	:	562-933-7874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/08/2007

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