Active NPI
Mark Anthony Gamboa Jr., PTA
- Physical Therapy Assistant
- Rocklin, CA
National Provider Identifier
1144977042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 51718
- Practice address
- 2217 Sunset Blvd Ste 711
Rocklin, CA 95765-4783 - Phone
- (916) 435-3500
- NPI assigned
- Mar 10, 2022
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 51718 | CA | Primary |
Addresses
Primary practice location
2217 Sunset Blvd Ste 711
Rocklin, CA 95765-4783
Mailing address
1200 Creekside Dr Apt 2128
Folsom, CA 95630-3440
Phone (209) 623-9702
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 |
|---|---|---|---|
| 51718 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646870400000",
"number": "1144977042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 CREEKSIDE DR APT 2128",
"city": "FOLSOM",
"state": "CA",
"postal_code": "956303440",
"telephone_number": "209-623-9702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2217 SUNSET BLVD STE 711",
"city": "ROCKLIN",
"state": "CA",
"postal_code": "957654783",
"telephone_number": "916-435-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAMBOA",
"first_name": "MARK",
"middle_name": "ANTHONY",
"name_suffix": "Jr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-10",
"last_updated": "2022-03-10",
"certification_date": "2022-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "51718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rocklin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.