| Gamboa Pllc | |
|
1173 W John Carpenter Fwy Ste 102 Irving TX 75039 | |
| (469) 947-6020 | |
| (469) 947-6021 |
| Full Name | Gamboa Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1173 W John Carpenter Fwy Ste 102, Irving, Texas |
| Authorized Official Name and Position | Daniela Gamboa Sejas (OWNER/PROVIDER) |
| Authorized Official Contact | 4699476020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gamboa Pllc 1173 W John Carpenter Fwy Ste 102 Irving TX 75039 Ph: (469) 947-6020 | Gamboa Pllc 1173 W John Carpenter Fwy Ste 102 Irving TX 75039 Ph: (469) 947-6020 |
| NPI Number | 1285225201 |
|---|---|
| Provider Enumeration Date | 02/02/2021 |
| Last Update Date | 02/08/2021 |
| Medicare PECOS PAC ID | 1254748817 |
|---|---|
| Medicare Enrollment ID | O20210325002534 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285225201 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Daniela Gamboa Sejas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417141912 PECOS PAC ID: 4587851266 Enrollment ID: I20101207000758 |
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