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NPI Code Detail

MEDICARE: SASHA GIBSON

MEDICARE:   SASHA  GIBSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12472R0900XRenal Dialysis Technician
2372600000XAdult Companion
3374U00000XHome Health Aide
4376K00000XNurse's AideTX

General Provider Information

NPI Number : 1679183156
Entity Type Code : Individual
Provider Name (Legal Business Name) : SASHA GIBSON
Provider Business Mailing Address
First Line : 4611 E HOUSTON ST APT 3004
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78220-1768
Country : US
Telephone Number : 414-306-3845
Fax Number :
Provider Business Practice Location Address
First Line : 4611 E HOUSTON ST APT 3004
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78220-1768
Country : US
Telephone Number : 414-306-3845
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2020
Last Update Date : 08/09/2020

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Directions to “ SASHA GIBSON ” Practice Location

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