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General NPI Number Information
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NPI Number | 1588118145
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Entity Type | Individual
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Provider Name | HENRY BRUCE GABON
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Gender | Male
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 315 N 3RD AVE STE 302
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City | COVINA
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State | CA
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Zip | 91723
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Country | US
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Telephone | 626-332-1194
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Fax | 626-915-3162
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Provider Business Mailing Address
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Address Line | PO BOX 4039
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City | ORANGE
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State | CA
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Zip | 92863-4039
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Country | US
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Telephone | 714-571-5000
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Fax | 714-571-5055
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA53751
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License Number State | CA
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