MEDICARE: GABRIELLA RENEE GAMBOA

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	2251G0304X	Geriatric Physical Therapist	LPT-034560	AZ
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1710827316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA RENEE GAMBOA

Provider Business Mailing Address
First Line	:	6215 N 14TH ST APT A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-1780
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10455 E PINNACLE PEAK PKWY
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-8173
Country	:	US
Telephone Number	:	480-669-1444
Fax Number	:

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

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	06/22/2026

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