Individual
MR. JOSE L GAMBOA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
9700 MASHBURN BLVD, OKLAHOMA CITY, OK 73162-5509
(405) 721-2466
Mailing address
9017 N UNIVERSITY AVE APT 14209, OKLAHOMA CITY, OK 73114-4312
(918) 320-1205
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
2694
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G082973974
DRIVERS LICENSE
OK
Enumeration date
05/14/2020
Last updated
05/14/2020
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