Healthcare Provider Details

I. General information

NPI: 1558285841
Provider Name (Legal Business Name): ORA GIBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S ST
SACRAMENTO CA
95811-6952
US

IV. Provider business mailing address

800 GIBSON DR APT 228
ROSEVILLE CA
95678-5777
US

V. Phone/Fax

Practice location:
  • Phone: 510-753-0879
  • Fax:
Mailing address:
  • Phone: 510-613-0330
  • Fax: 510-569-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: