Active NPI
Edwin Arnoldo Gamboa
- Speech-Language Pathologist
- Tavares, FL
National Provider Identifier
1306130828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SZ5326
- Practice address
- 2760 Dora Ave
Tavares, FL 32778 - Phone
- (352) 742-7837
- Fax
- (352) 508-5113
- NPI assigned
- Jun 1, 2011
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SZ5326 | FL | Primary |
Addresses
Primary practice location
2760 Dora Ave
Tavares, FL 32778
Mailing address
2760 Dora Ave
Tavares, FL 32778
Phone (352) 742-7837
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 |
|---|---|---|---|
| SZ5326 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306886400000",
"number": "1306130828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2760 DORA AVE",
"city": "TAVARES",
"state": "FL",
"postal_code": "32778",
"telephone_number": "352-742-7837",
"fax_number": "352-508-5113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2760 DORA AVE",
"city": "TAVARES",
"state": "FL",
"postal_code": "32778",
"telephone_number": "352-742-7837",
"fax_number": "352-508-5113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAMBOA",
"first_name": "EDWIN",
"middle_name": "ARNOLDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-01",
"last_updated": "2011-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SZ5326",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tavares, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.