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General NPI Number Information
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NPI Number | 1447679964
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Entity Type | Individual
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Provider Name | MEREDITH LYNN GIBBONS DO
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Gender | Female
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Dates
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Enumeration Date | 04/11/2014
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 1117 E DEVONSHIRE AVE
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City | HEMET
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State | CA
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Zip | 92543-3083
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Country | US
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Telephone | 951-652-2811
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Fax |
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Provider Business Mailing Address
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Address Line | 11315 BRIDGEPORT WAY SW
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City | LAKEWOOD
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State | WA
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Zip | 98499-3004
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Country | US
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Telephone | 253-426-6341
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Fax | 253-426-6344
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OP61055810
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | OP61055810
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A15633
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License Number State | CA
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