Gamboa, Jacqueline Michelle

Gamboa, Jacqueline Michelle is an sole proprietor health care provider with primary practice located at 12625 High Bluff Dr Suite 114, San Diego CA 92130-2052. She recently has 5 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Family, Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Gamboa, Jacqueline Michelle can be contacted via phone (858) 492-8445.

Contact Information

Primary practice address
12625 High Bluff Dr Suite 114 San Diego CA 92130-2052
Phone: (858) 492-8445
Fax: (858) 492-8445
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 103TA0400X PSY22784 California
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY22784 California
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X PSY22784 California
Behavioral Health & Social Service Providers / Family 103TF0000X PSY22784 California
Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities 103TM1800X PSY22784 California

Profile Details

NPI number 1083948046
LBN Legal business name Gamboa, Jacqueline Michelle
Credentials PSY.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 23rd, 2009
Last updated Jun 3rd, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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