Provider Demographics
NPI:1598242141
Name:GAMBOA, JAMIE MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MICHELLE
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 LANKERSHIM BLVD
Mailing Address - Street 2:STE 545
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602
Mailing Address - Country:US
Mailing Address - Phone:323-999-1395
Mailing Address - Fax:
Practice Address - Street 1:4605 LANKERSHIM BLVD
Practice Address - Street 2:STE 545
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602
Practice Address - Country:US
Practice Address - Phone:323-999-1395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32955103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical