Healthcare Provider Details

I. General information

NPI: 1679989420
Provider Name (Legal Business Name): ERI GIBB DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 S RAINBOW BLVD STE 101
LAS VEGAS NV
89146-9047
US

IV. Provider business mailing address

8379 W SUNSET RD STE 210
LAS VEGAS NV
89113-2243
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-2287
  • Fax: 702-476-2035
Mailing address:
  • Phone: 702-476-2595
  • Fax: 725-200-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT015791
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2264
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: