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General NPI Number Information
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NPI Number | 1770770810
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Entity Type | Individual
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Provider Name | JENNIFER DAINE GIBBONS
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Gender | Female
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 11776 MARIPOSA RD
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City | HESPERIA
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State | CA
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Zip | 92345-1622
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Country | US
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Telephone | 760-956-2462
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Fax |
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Provider Business Mailing Address
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Address Line | 9675 MIGNONETTE ST
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City | ALTA LOMA
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State | CA
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Zip | 91701-5027
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Country | US
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Telephone | 909-636-1788
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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