Healthcare Provider Details

I. General information

NPI: 1407098288
Provider Name (Legal Business Name): MATTHEW GIBBONS PARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 EDISON WAY
RENO NV
89502-4100
US

IV. Provider business mailing address

PO BOX 18851
RENO NV
89511-0167
US

V. Phone/Fax

Practice location:
  • Phone: 775-858-3303
  • Fax:
Mailing address:
  • Phone: 775-571-4766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number14433
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14433
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: