Provider Demographics
NPI:1396106605
Name:GAMBINO, MEGAN R (SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:R
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 MILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-5306
Mailing Address - Country:US
Mailing Address - Phone:951-750-9494
Mailing Address - Fax:
Practice Address - Street 1:1500 S HAVEN AVE STE 190
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2971
Practice Address - Country:US
Practice Address - Phone:909-390-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist