Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | A87245 | CA |
Y | 207VX0000X | Obstetrician | A87245 | CA |
NPI | 1285658690 |
---|---|
Provider Name | Joslyn Lois Gumbs |
First Address | Pasadena, CA 91105-2158 |
Second Address | Los Angeles, CA 90027-6091 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 28/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A872450 | (05) | CA |
00A872450 | BLUE SHIELD (01) | CA |