1457881203 NPI number — GAMBINO FULL OF LIFE CHIROPRACTIC, INC

Table of content: (NPI 1457881203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457881203 NPI number — GAMBINO FULL OF LIFE CHIROPRACTIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAMBINO FULL OF LIFE CHIROPRACTIC, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457881203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1176
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARDIFF
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92007-7176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-509-7999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6030 SANTO RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92124-1196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-541-0505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GAMBINO
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
858-541-0505

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC31087 . This is a "LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com