MEDICARE: JOHN GAMBOL M.D.

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	207P00000X	Emergency Medicine Physician	G87090	CA
2	207P00000X	Emergency Medicine Physician	ME70844	FL
3	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	G87090	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	606478700	OTHER	FL	DOL GRP#
3	ME70844	OTHER	FL	LICENSE#
4	58630	OTHER	FL	GRP# 98513
5	G87090	OTHER	CA	LICENSE#

General Provider Information

NPI Number	:	1255339826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GAMBOL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9126
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91309-0126
Country	:	US
Telephone Number	:	818-709-8161
Fax Number	:	818-709-8160

Provider Business Practice Location Address
First Line	:	1041 E YORBA LINDA BLVD STE 203
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3762
Country	:	US
Telephone Number	:	818-709-8161
Fax Number	:	818-709-8160

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	12/13/2018

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Directions to “ JOHN GAMBOL M.D.” Practice Location

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