Provider Demographics
NPI:1023993805
Name:GAMBOA, AMELY
Entity type:Individual
Prefix:
First Name:AMELY
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMELY
Other - Middle Name:
Other - Last Name:GAMBOA LANDESTOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10765 SW 108TH AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8105
Mailing Address - Country:US
Mailing Address - Phone:305-282-9109
Mailing Address - Fax:
Practice Address - Street 1:10765 SW 108TH AVE APT 308
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8105
Practice Address - Country:US
Practice Address - Phone:305-282-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104653171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter