Edgar Gamboa, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

C41857 Issued in CA

Practice address

243 Green Valley Rd
Ste. D
Freedom, CA 95019-3133

Phone

(831) 724-7874

Fax

(831) 724-4339

NPI assigned

Nov 27, 2006

Last updated

Aug 29, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA, UT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hazel Hawkins Memorial Hospital

  dba San Benito Health Care District

  • General Acute Care Hospital
  • Hollister, CA
  • NPI 1275578817
  Medicare reassignment NPD
• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  Medicare reassignment NPD
• Edgar a. Gamboa, M.D. Medical Corp

  • Surgery Physician
  • Freedom, CA
  • NPI 1063684561
  Authorized official Same address or phone
• Hazel Hawkins Memorial Hospital

  dba Hazel Hawkins primary Care & Surgical Specialty Center

  • Rural Health Clinic/Center
  • Hollister, CA
  • NPI 1013628353
  NPD
• Uintah Basin Medical Center

  dba Uintah Basin Healthcare Vernal Pharmacy

  • Community/Retail Pharmacy
  • Vernal, UT
  • NPI 1285420414
  NPD

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1265508980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 HARTNELL ST",
            "address_2": "STE 200",
            "city": "MONTEREY",
            "state": "CA",
            "postal_code": "939402834",
            "telephone_number": "831-324-0176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 GREEN VALLEY RD",
            "address_2": "STE. D",
            "city": "FREEDOM",
            "state": "CA",
            "postal_code": "950193133",
            "telephone_number": "831-724-7874",
            "fax_number": "831-724-4339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBOA",
        "first_name": "EDGAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "C41857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C418570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Erickson, DDS
• Fastrackmed Urgent Care Inc
• Frederick W.K. Chen
• Freedom Acupuncture and Integrative Medicine
• James Joseph Gallagher, M.D.
• Lucie N. Gamboa, M.D.
• Debra Garcia
• Vanessa Garnica, NURSE PRACTITIONER
• Generations Health Care for Women a Medical Corporation
• Gordon Gardner Goldstine, DDS

• Surgery Physician in Freedom, CA
• Providers in Freedom, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.