Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | G40440 | CA |
NPI | 1124238308 |
---|---|
Provider Name | Dr. Kathryn A. Gibbs |
First Address | Villa Park, CA 92861-2710 |
Second Address | Villa Park, CA 92861-2710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |