Individual
KENNETH JONAVIL P GAMBOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7110 STEIGER HILL RD, VACAVILLE, CA 95688-9789
(707) 656-6625
Mailing address
1806 WOOD DUCK CT, AMERICAN CANYON, CA 94503-3125
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
21-155551
CA
167G00000X
Licensed Psychiatric Technician
Primary
40215
CA
Other
Enumeration date
11/07/2024
Last updated
11/07/2024
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