MEDICARE: BERNARD S GIBESON

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	1317830001	CA

General Provider Information

NPI Number	:	1821208943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNARD S GIBESON

Provider Business Mailing Address
First Line	:	1900 W REDONDO BEACH BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3624
Country	:	US
Telephone Number	:	310-630-5885
Fax Number	:	310-630-0189

Provider Business Practice Location Address
First Line	:	1900 W REDONDO BEACH BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3624
Country	:	US
Telephone Number	:	310-630-5885
Fax Number	:	310-630-0189

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BERNARD S GIBESON
Credential	:
Telephone Number	:	310-630-5885

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	06/20/2008

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