Healthcare Provider Details

I. General information

NPI: 1598976102
Provider Name (Legal Business Name): LISA GAY VILLONE-GIBBONEY N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W 6TH ST
CORONA CA
92882-3237
US

IV. Provider business mailing address

737 LA DOCENA LN
CORONA CA
92879-8535
US

V. Phone/Fax

Practice location:
  • Phone: 951-279-3929
  • Fax: 951-279-3929
Mailing address:
  • Phone: 951-817-1081
  • Fax: 951-817-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: