Healthcare Provider Details

I. General information

NPI: 1285658690
Provider Name (Legal Business Name): JOSLYN LOIS GUMBS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE STE 804
LOS ANGELES CA
90027-6091
US

IV. Provider business mailing address

1680 LA LOMA ROAD
PASADENA CA
91105-2158
US

V. Phone/Fax

Practice location:
  • Phone: 323-257-1814
  • Fax: 323-257-1314
Mailing address:
  • Phone: 323-385-8662
  • Fax: 323-257-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA87245
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA87245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: