Manuel Gambino, CI42710524

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

117 East Harry Bridges Boulevard
Wilmington, CA 90744

Phone

(310) 549-8383

Fax

(310) 835-1202

NPI assigned

Sep 14, 2020

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 names 1

• Manuel Gambino Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1600041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1801401963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 EAST HARRY BRIDGES BOULEVARD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "90744",
            "telephone_number": "310-549-8383",
            "fax_number": "310-835-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 EAST HARRY BRIDGES BOULEVARD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "90744",
            "telephone_number": "310-549-8383",
            "fax_number": "310-835-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBINO",
        "first_name": "MANUEL",
        "name_prefix": "Mr.",
        "credential": "CI42710524",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-14",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANUEL",
            "last_name": "GAMBINO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in Wilmington, CA
• Providers in Wilmington, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; 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.