Healthcare Provider Details

I. General information

NPI: 1528275310
Provider Name (Legal Business Name): GIA HUMELBAUGH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD 2ND FLOOR, FAMILY MEDICINE CLINIC
HARBOR CITY CA
90710-2076
US

IV. Provider business mailing address

PO BOX 2294
MANHATTAN BEACH CA
90267-2294
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-7600
  • Fax:
Mailing address:
  • Phone: 310-702-6305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA95749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: