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NPI Code Detail

MEDICARE: MARK GAMBALA MA

MEDICARE:   MARK  GAMBALA  MA
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1952591950
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK GAMBALA MA
Provider Business Mailing Address
First Line : 1255 ALLSTON WAY
Second Line :
City : BERKELEY
State : CA
Zip : 94702-1833
Country : US
Telephone Number : 510-845-9010
Fax Number :
Provider Business Practice Location Address
First Line : 1255 ALLSTON WAY
Second Line :
City : BERKELEY
State : CA
Zip : 94702-1833
Country : US
Telephone Number : 510-845-9010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2007
Last Update Date : 09/29/2008

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Directions to “ MARK GAMBALA MA” Practice Location

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