Basic Information
| Provider Information | |||||||||
| NPI: | 1144563370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAMBOA | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9357 W EMERALD ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837049752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086721000 | ||||||||
| FaxNumber: | 2086721010 | ||||||||
| Practice Location | |||||||||
| Address1: | 9357 W EMERALD ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086721000 | ||||||||
| FaxNumber: | 2086721010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2013 | ||||||||
| LastUpdateDate: | 08/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0001X | M-14142 | ID | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.