Healthcare Provider Details

I. General information

NPI: 1225107063
Provider Name (Legal Business Name): JULIE ANN GIBLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14372 BEACH BLVD
WESTMINSTER CA
92683-4578
US

IV. Provider business mailing address

115 CALLE MAYOR
REDONDO BEACH CA
90277-6509
US

V. Phone/Fax

Practice location:
  • Phone: 714-891-0955
  • Fax:
Mailing address:
  • Phone: 310-283-9273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN293935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: