Provider Demographics
NPI:1811887920
Name:GAMBOA, KAYLA
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 S PLAZA TRL STE 150A
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3371
Mailing Address - Country:US
Mailing Address - Phone:407-301-1538
Mailing Address - Fax:
Practice Address - Street 1:3630 S PLAZA TRL STE 150A
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3371
Practice Address - Country:US
Practice Address - Phone:407-301-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health