Requeijo-Gamboa Epc Aco LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

REQUEIJO-GAMBOA EPC ACO LLC

Practice address

1001 Mountain St
Carson City, NV 89703-3848

Phone

(737) 226-6700

NPI assigned

May 12, 2021

Organization subpart

No

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

Authorized official

Name

Antonio Gamboa, MD

Title

Owner

Phone

(737) 226-6700

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1700460938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901A SPICEWOOD SPRINGS RD STE 201",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787598728",
            "telephone_number": "737-226-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 MOUNTAIN ST",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897033848",
            "telephone_number": "737-226-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REQUEIJO-GAMBOA EPC ACO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-12",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "GAMBOA",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "737-226-6700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Carson City, NV
• Providers in Carson City, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; 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.