Organization
BOXIDARA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN S GAMBOL M.D. (PRESIDENT)
(818) 709-8161
Entity
Organization
Contact information
Practice address
38660 MEDICAL CENTER DR STE A150, C/O PALMDALE MED. CTR. WOUND CARE CLINIC, PALMDALE, CA 93551-4385
(818) 709-8161
(818) 709-8160
Mailing address
PO BOX 9126, CANOGA PARK, CA 91309-0126
(818) 709-8161
(818) 709-8160
Taxonomy
Speciality
Code
Description
License number
State
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
G67090
CA
Other
Enumeration date
05/03/2011
Last updated
06/20/2018
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