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NPI Code Detail

MEDICARE: DELANIZE GIBSON

MEDICARE:   DELANIZE  GIBSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1679437438
Entity Type Code : Individual
Provider Name (Legal Business Name) : DELANIZE GIBSON
Provider Business Mailing Address
First Line : 2550 N HOLLYWOOD WAY STE 301
Second Line :
City : BURBANK
State : CA
Zip : 91505-5025
Country : US
Telephone Number : 866-727-8274
Fax Number :
Provider Business Practice Location Address
First Line : 3257 E GUASTI RD STE 210
Second Line :
City : ONTARIO
State : CA
Zip : 91761-1235
Country : US
Telephone Number : 866-727-8274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2025
Last Update Date : 12/15/2025

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Directions to “ DELANIZE GIBSON ” Practice Location

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