Healthcare Provider Details

I. General information

NPI: 1124238308
Provider Name (Legal Business Name): KATHRYN A. GIBBS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. KATHRYN G. RYAN

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 RYAN CIR
VILLA PARK CA
92861-2710
US

IV. Provider business mailing address

9811 RYAN CIR
VILLA PARK CA
92861-2710
US

V. Phone/Fax

Practice location:
  • Phone: 714-998-4206
  • Fax: 714-998-4206
Mailing address:
  • Phone: 714-998-4206
  • Fax: 714-998-4206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG40440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: