Active NPI
Darcesean Gamble, PA
- Physician Assistant
- Sherman Oaks, CA
National Provider Identifier
1003012162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA 15713
- Practice address
- 4955 Van Nuys Blvd Ste 411
Sherman Oaks, CA 91403-1824 - Phone
- (818) 784-1195
- NPI assigned
- Jun 25, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 15713 | CA | Primary |
Addresses
Primary practice location
4955 Van Nuys Blvd Ste 411
Sherman Oaks, CA 91403-1824
Mailing address
5137 Onaknoll Ave
Los Angeles, CA 90043-1039
Phone (310) 403-2510
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15713 | CA | MD | Speech-Language Pathologist |
| PA 15713 | CA | MD | Physician Assistant |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/2ff937d5-49c0-4d88-b923-0f5bdcf3b04f/
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003012162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5137 ONAKNOLL AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900431039",
"telephone_number": "310-403-2510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4955 VAN NUYS BLVD STE 411",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914031824",
"telephone_number": "818-784-1195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAMBLE",
"first_name": "DARCESEAN",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA 15713",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sherman Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.