Individual
ADRIEL IIRAM GAMBOA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3830 COMMONS AVE NE, ALBUQUERQUE, NM 87109-5831
(505) 424-1239
Mailing address
PO BOX 33286, SANTA FE, NM 87594-3286
(505) 424-1239
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2091
NM
Other
Enumeration date
07/05/2023
Last updated
07/05/2023
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