Provider Demographics
NPI:1891265690
Name:GAMBLETON, LATRICIA MAY
Entity type:Individual
Prefix:
First Name:LATRICIA
Middle Name:MAY
Last Name:GAMBLETON
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 1:3900 TELEPORT BLVD UNIT 143144
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75014-0227
Mailing Address - Country:US
Mailing Address - Phone:866-473-6899
Mailing Address - Fax:
Practice Address - Street 1:8585 N STEMMONS FWY STE 416
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3836
Practice Address - Country:US
Practice Address - Phone:866-473-6899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)