Healthcare Provider Details

I. General information

NPI: 1922444009
Provider Name (Legal Business Name): JOANNA FRANCIS GIBBONS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LAKE ST
KENAI AK
99611-6937
US

IV. Provider business mailing address

800 S VICTORIA AVE, L4615 VCHCA - PHYSICIAN SERVICES
VENTURA CA
93009-0003
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4025
  • Fax:
Mailing address:
  • Phone: 805-677-5181
  • Fax: 805-677-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: