Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A101342 | CA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | A101342 | CA |
NPI | 1104004365 |
---|---|
Provider Name | Leena Caroline Gibson |
First Address | West Hollywood, CA 90048-1804 |
Second Address | West Hollywood, CA 90048-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2008 |
Last Update Date | 06/09/2013 |