DR. JACQUELINE MICHELLE GAMBOA (NPI# 1083948046) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083948046 |
| Entity Type | Individual |
| Full Name | DR. JACQUELINE MICHELLE GAMBOA |
| Credential | PSY.D. |
| Practice Address |
12625 High Bluff Dr Suite 114 San Diego CA 92130-2052 |
| Mailing Address |
Po Box 904 La Jolla CA 92038-0904 |
| Practice Telephone | 8584928445 |
| Practice Fax Number | 8584928445 |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2010-06-03 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
PSY22784 | CA | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PSY22784 | CA | Behavioral Health & Social Service Providers |
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
PSY22784 | CA | Behavioral Health & Social Service Providers |
| N | 103TF0000X |
Psychologist Specialization: Family |
PSY22784 | CA | Behavioral Health & Social Service Providers |
| N | 103TM1800X |
Psychologist Specialization: Mental Retardation & Developmental Disabilities |
PSY22784 | CA | Behavioral Health & Social Service Providers |
| Street Address |
12625 HIGH BLUFF DR SUITE 114 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92130-2052 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902851900 | Lagasse Yates, Inc | Psychologist | 12625 High Bluff Dr, Suite 206, San Diego, CA 92130-2052 | 2006-05-24 |
| 1659877611 | Rachel Beaubier | Registered Nurse | 12625 High Bluff Dr, San Diego, CA 92130-2052 | 2018-03-30 |
| 1609284769 | Katie Tiemeyer | Speech-Language Pathologist | 12625 High Bluff Dr, Suite 105, San Diego, CA 92130-2052 | 2014-07-31 |
| 1386056240 | Caroline Morin | Psychiatry & Neurology | 12625 High Bluff Dr, Suite 305, San Diego, CA 92130-2052 | 2014-05-27 |
| 1598189375 | Botkiss Center for Tms Therapy | Psychiatry & Neurology | 12625 High Bluff Dr, Suite 312, San Diego, CA 92130-2052 | 2014-02-13 |
| 1760826705 | Deborah G Mishek | Pediatrics | 12625 High Bluff Dr, Suite 302, San Diego, CA 92130-2052 | 2013-04-22 |
| 1457604639 | Kris Gremillion | Speech-Language Pathologist | 12625 High Bluff Dr, Suite 113, San Diego, CA 92130-2052 | 2012-10-24 |
| 1477836856 | Jonathan Ortiz | Social Worker | 12625 High Bluff Dr, Suite 305, San Diego, CA 92130-2052 | 2011-09-22 |
| 1376830331 | Kimberly Ducker | Specialist/Technologist | 12625 High Bluff Dr, Suite #113, San Diego, CA 92130-2052 | 2011-06-28 |
| 1770711442 | Minoa K Chang | Psychologist | 12625 High Bluff Dr, Suite 316, San Diego, CA 92130-2052 | 2009-07-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629692397 | Tlc Family Therapy | Marriage & Family Therapist | 5965 Village Way. Suite 105 #112, San Diego, CA 92130 | 2020-05-29 |
| 1447746169 | Jack Perlov | Psychiatry & Neurology | 3535 Caminito El Rincon, Unit 268, San Diego, CA 92130 | 2018-07-05 |
| 1326551003 | Theotokos, LLC | Pharmacy | 5550 Carmel Mountain Rd Ste 111, San Diego, CA 92130 | 2017-11-16 |
| 1154879146 | Halie Hommes | Occupational Therapist | 12250 El Camino Real Ste 250, San Diego, CA 92130 | 2016-09-19 |
| 1790232015 | Coastal Skin and Eye Institute, Inc. | Ophthalmology | 5550 Carmel Mountain Road, Suite 206, San Diego, CA 92130 | 2016-09-02 |
| 1720534951 | Nosti and Rygg Dental Corporation | Dentist | 5550 Carmel Mountain Road, Ste 200, San Diego, CA 92130 | 2016-08-28 |
| 1831644053 | Marco Savittieri | Dentist | 3715 Ruette De Vl, San Diego, CA 92130 | 2016-08-17 |
| 1336508621 | Discovery Practice Management, Inc | Psychiatric Residential Treatment Facility | 11455 Camino Real, Ste 360, San Diego, CA 92130 | 2016-02-16 |
| 1427434679 | Coast Pediatrics Carmel Valley | Pediatrics | 5965 Village Drive, Suite 201, San Diego, CA 92130 | 2015-08-10 |
| 1659753762 | T Sidal Dds Md Inc | Dentist | 12395 El Camino Real, Suite 304, Torrey Pines Oral & Maxillofacial Surgery, San Diego, CA 92130 | 2015-06-25 |
| Find all providers in zip 92130 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184231730 | Joanna Lesley Kaye | Psychologist | 3555 Rosecrans St Ste 114-212, San Diego, CA 92110-3231 | 2020-09-28 |
| 1396353520 | Chandra Estelle Khalifian | Psychologist | 4975 Foothill Blvd, San Diego, CA 92109-2236 | 2020-07-14 |
| 1225661838 | Sharon Saeedi Psy D Psychologist Inc | Psychologist | 185 W F St Ste 100l, San Diego, CA 92101-6029 | 2020-02-21 |
| 1609414242 | Laura Beth Fitzpatrick | Psychologist | 3322 29th St, San Diego, CA 92104-4533 | 2019-12-13 |
| 1790329613 | Growgood Psychology, Corp | Psychologist | 3405 Kenyon St # 513-06, San Diego, CA 92110-5003 | 2019-11-04 |
| 1891355996 | Stephanie Ann Massey | Psychologist | 12625 High Bluff Dr Ste 206, San Diego, CA 92130-2053 | 2019-06-19 |
| 1225697543 | Dr. Emily N. Kierce, Psychologist, A Professional Corporation | Psychologist | 402 W Broadway Ste 1925, San Diego, CA 92101-8505 | 2019-06-10 |
| 1023674884 | Desiree Arlene Cuevas | Psychologist | 2525 Camino Del Rio S Ste 305, San Diego, CA 92108-3784 | 2019-05-16 |
| 1396212023 | Paul William Randolph | Psychologist | 727 Robinson Ave Apt D, San Diego, CA 92103-4364 | 2018-10-31 |
| 1952876526 | Amanda Cooney | Psychologist | 2515 Old Quarry Rd Apt 1314, San Diego, CA 92108-2759 | 2018-10-09 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.