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General NPI Number Information
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NPI Number | 1184273187
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Entity Type | Individual
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Provider Name | JASIRI DEJAHN GIBSON
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Gender | Male
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 1149 A ST
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City | HAYWARD
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State | CA
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Zip | 94541-4113
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Country | US
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Telephone | 510-901-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 1675 80TH AVE
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City | OAKLAND
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State | CA
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Zip | 94621-2337
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Country | US
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Telephone | 510-940-6226
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | E3514847
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License Number State | CA
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