Active NPI
Kenneth Jonavil P Gamboa
- Licensed Psychiatric Technician
- Vacaville, CA
National Provider Identifier
1841013885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 40215
- Practice address
- 7110 Steiger Hill Rd
Vacaville, CA 95688-9789 - Phone
- (707) 656-6625
- NPI assigned
- Nov 7, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 21-155551 | CA | |
| Licensed Psychiatric Technician | 167G00000X | 40215 | CA | Primary |
Addresses
Primary practice location
7110 Steiger Hill Rd
Vacaville, CA 95688-9789
Mailing address
1806 Wood Duck CT
American Canyon, CA 94503-3125
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 |
|---|---|---|---|
| 21-155551 | CA | MD | Behavior Technician |
| 40215 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730937600000",
"number": "1841013885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1806 WOOD DUCK CT",
"city": "AMERICAN CANYON",
"state": "CA",
"postal_code": "945033125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7110 STEIGER HILL RD",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956889789",
"telephone_number": "707-656-6625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAMBOA",
"first_name": "KENNETH JONAVIL",
"middle_name": "P",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-07",
"last_updated": "2024-11-07",
"certification_date": "2024-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "21-155551",
"primary": false
},
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "40215",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vacaville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.