Provider Demographics
NPI:1174722680
Name:GAMO, MARIA VICTORIA GAUDINEZ (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIA VICTORIA
Middle Name:GAUDINEZ
Last Name:GAMO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43120 GRIMMER TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-6634
Mailing Address - Country:US
Mailing Address - Phone:510-668-1581
Mailing Address - Fax:
Practice Address - Street 1:34400 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3604
Practice Address - Country:US
Practice Address - Phone:510-429-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist