MEDICARE: DR. THELMA YESENIA GAMBOA-MALDONADO DRPH, MPH, CHW

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	172V00000X	Community Health Worker		CA

General Provider Information

NPI Number	:	1811820608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THELMA YESENIA GAMBOA-MALDONADO DRPH, MPH, CHW

Provider Business Mailing Address
First Line	:	1535 S D ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3253
Country	:	US
Telephone Number	:	909-884-3735
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 S D ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3253
Country	:	US
Telephone Number	:	909-884-3735
Fax Number	:

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

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

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