Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | G79479 | CA |
NPI | 1467432609 |
---|---|
Provider Name | David Len Gibbs |
First Address | Orange, CA 92868-4509 |
Second Address | Orange, CA 92868-4509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 05/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G794790 | (05) | CA |
F90732 | (02) | CA |