Provider Demographics
NPI:1447907555
Name:GAMBINO, JESUS
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:GAMBINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MADEIRA AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4644
Mailing Address - Country:US
Mailing Address - Phone:760-641-6720
Mailing Address - Fax:
Practice Address - Street 1:15 MADEIRA AVE APT 9
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4644
Practice Address - Country:US
Practice Address - Phone:760-641-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9359625163W00000X
FLRN9359625163WI0500X
FLF03220422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy