MEDICARE: MALINDA GIBBONS L.AC.

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
1	171100000X	Acupuncturist	8720	CA

General Provider Information

NPI Number	:	1679981682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALINDA GIBBONS L.AC.

Provider Business Mailing Address
First Line	:	731 W ELDER ST UNIT B
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-2815
Country	:	US
Telephone Number	:	619-244-8998
Fax Number	:

Provider Business Practice Location Address
First Line	:	1667 S MISSION RD STE A
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-4119
Country	:	US
Telephone Number	:	619-244-8998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	12/27/2021

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