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NPI Code Detail

MEDICARE: DANISHA GIBSON LVN

MEDICARE: DANISHA GIBSON LVN
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
1164X00000XLicensed Vocational NurseVN187762CA

General Provider Information

NPI Number : 1497886113
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANISHA GIBSON LVN
Provider Business Mailing Address
First Line : 1616 W 124TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-5220
Country : US
Telephone Number : 323-757-5411
Fax Number :
Provider Business Practice Location Address
First Line : 1701 CAMINO PALMERO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90046-2902
Country : US
Telephone Number : 323-876-0550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/08/2007

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