Basic Information
| Provider Information | |||||||||
| NPI: | 1447868476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAMBOA NAVA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | GUADALUPE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 261 1/2 S ARROYO DR | ||||||||
| Address2: | |||||||||
| City: | SAN GABRIEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917761001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267591034 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1855 W KATELLA AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928673432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143993480 | ||||||||
| FaxNumber: | 7143993481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2020 | ||||||||
| LastUpdateDate: | 08/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.