Basic Information
| Provider Information | |||||||||
| NPI: | 1992385397 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAMBOA | ||||||||
| FirstName: | SANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31784 MONACO CT | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925968327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096412565 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925432960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517913300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2021 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.