Active NPI
Jacqueline Michelle Gamboa, PSY.D.
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1083948046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY22784
- Practice address
- 12625 High Bluff Dr
Suite 114
San Diego, CA 92130-2052 - Phone
- (858) 492-8445
- Fax
- (858) 492-8445
- NPI assigned
- Sep 23, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | PSY22784 | CA | |
| Clinical Psychologist | 103TC0700X | PSY22784 | CA | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSY22784 | CA | |
| Family Psychologist | 103TF0000X | PSY22784 | CA | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | PSY22784 | CA |
Addresses
Primary practice location
12625 High Bluff Dr
Suite 114
San Diego, CA 92130-2052
Mailing address
PO Box 904
La Jolla, CA 92038-0904
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY22784 | CA | MD | Family Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275523200000",
"number": "1083948046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 904",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920380904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12625 HIGH BLUFF DR",
"address_2": "SUITE 114",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302052",
"telephone_number": "858-492-8445",
"fax_number": "858-492-8445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAMBOA",
"first_name": "JACQUELINE",
"middle_name": "MICHELLE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-23",
"last_updated": "2010-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "PSY22784",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY22784",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "CA",
"license": "PSY22784",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "CA",
"license": "PSY22784",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "CA",
"license": "PSY22784",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.