Provider Demographics
NPI:1093690042
Name:GAMBOA, JAIME (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 MARCELLE ST
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4729
Mailing Address - Country:US
Mailing Address - Phone:562-884-8218
Mailing Address - Fax:
Practice Address - Street 1:12539 IMPERIAL HWY STE 201
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3106
Practice Address - Country:US
Practice Address - Phone:562-379-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist