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NPI Code Detail

MEDICARE: ROBERT NORTH GIBSON P.A.

MEDICARE: ROBERT NORTH GIBSON P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5892AZ
2363A00000XPhysician AssistantPA21862CA

General Provider Information

NPI Number : 1457634008
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT NORTH GIBSON P.A.
Provider Business Mailing Address
First Line : 20422 MOONCREST CIR
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92646-4748
Country : US
Telephone Number : 714-390-2072
Fax Number :
Provider Business Practice Location Address
First Line : 3801 S HARBOR BLVD
Second Line :
City : SANTA ANA
State : CA
Zip : 92704-7901
Country : US
Telephone Number : 714-751-5555
Fax Number : 714-751-9999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2011
Last Update Date : 09/22/2022

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