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General NPI Number Information
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NPI Number | 1750733671
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Entity Type | Individual
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Provider Name | JAKE GILBERT PTA,
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Gender | Male
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Dates
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Enumeration Date | 07/02/2016
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 808 ADAMS AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5488
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Country | US
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Telephone | 714-369-9328
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Fax |
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Provider Business Mailing Address
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Address Line | 8941 ATLANTA AVE 355
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646
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Country | US
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Telephone | 714-369-9328
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 48099
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License Number State | CA
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