1346396272 NPI number — MS. SEANNE CECELIA GIBSON LM, CPM

Table of content: MS. SEANNE CECELIA GIBSON LM, CPM (NPI 1346396272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346396272 NPI number — MS. SEANNE CECELIA GIBSON LM, CPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBSON
Provider First Name:
SEANNE
Provider Middle Name:
CECELIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LM, CPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIBSON
Provider Other First Name:
SEANNIE
Provider Other Middle Name:
CECELIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LM, CPM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1346396272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
496 RAINBOW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90065-3952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-221-7822
Provider Business Mailing Address Fax Number:
323-221-8889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
496 RAINBOW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90065-3952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-221-7822
Provider Business Practice Location Address Fax Number:
323-221-8889
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  LM 171 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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