Healthcare Provider Details

I. General information

NPI: 1043326366
Provider Name (Legal Business Name): ROBERT L.R. GIBBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24325 CRENSHAW BLVD # 283
TORRANCE CA
90505-5349
US

IV. Provider business mailing address

24325 CRENSHAW BLVD # 283
TORRANCE CA
90505-5349
US

V. Phone/Fax

Practice location:
  • Phone: 424-777-6642
  • Fax: 877-223-4535
Mailing address:
  • Phone: 424-777-6642
  • Fax: 877-223-4535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA73898
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA73898
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberA73989
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA73989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: