Jose L Gamboa Jr., PTA

Primary specialty

Geriatric Physical TherapistTaxonomy code 2251G0304X

License

2694 Issued in OK

Practice address

9700 Mashburn Blvd
Oklahoma City, OK 73162-5509

Phone

(405) 721-2466

NPI assigned

May 14, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589414400000",
    "number": "1114549920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9017 N UNIVERSITY AVE APT 14209",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731144312",
            "telephone_number": "918-320-1205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9700 MASHBURN BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731625509",
            "telephone_number": "405-721-2466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBOA",
        "first_name": "JOSE",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-14",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "OK",
            "license": "2694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "G082973974",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "jlgambo52@gmail.com",
            "affiliation": "N",
            "address_1": "9017 N University Ave Apt 14209",
            "city": "Oklahoma City",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731144312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Miguel Galvan Duran, M.D.
• Fariana Thalia Galvan, COTA
• Sky Gamble
• Jennifer Juanita Gamblin, PA-C
• Alberto Gamboa
• Blake Gammill
• Robert Glen Gammon Jr., LICENSED HEARING AID
• Tara Linden Gamsjager, LPC
• Daniel Alexeev Ganchev, CRNA
• Adithi Gandhi

• Geriatric Physical Therapist in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Geriatric Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.