Active NPI
Julio C Gamboa
- Community Health Worker
- Fresno, CA
National Provider Identifier
1376176016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 153 N U St
Fresno, CA 93701-2438 - Phone
- (559) 445-9094
- NPI assigned
- Feb 21, 2020
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
153 N U St
Fresno, CA 93701-2438
Mailing address
153 N U St
Fresno, CA 93701-2438
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5594459083 | Other | CA | CONTACT |
| 5594459094 | Other | CA | CONTACT |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crestwood Behavioral Health, Inc. | Past | Accepting new patients | |
| Fresno County Crestwood Fresno Bridge | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Illness Community Based Residential Treatment Facility
- Fresno, CA
- NPI 1093892663
-
- Psychiatric Residential Treatment Facility
- Fresno, CA
- NPI 1558499749
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687996800000",
"number": "1376176016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "153 N U ST",
"city": "FRESNO",
"state": "CA",
"postal_code": "937012438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "153 N U ST",
"city": "FRESNO",
"state": "CA",
"postal_code": "937012438",
"telephone_number": "559-445-9094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAMBOA",
"first_name": "JULIO",
"middle_name": "C",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-02-21",
"last_updated": "2023-06-29",
"certification_date": "2023-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONTACT",
"identifier": "5594459083",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONTACT",
"identifier": "5594459094",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.