Provider Demographics
NPI:1154066496
Name:GIBBINS, BEN WRIGHT
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:WRIGHT
Last Name:GIBBINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 S 2ND AVE STE D
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3043
Mailing Address - Country:US
Mailing Address - Phone:626-966-1577
Mailing Address - Fax:626-331-4529
Practice Address - Street 1:536 S 2ND AVE STE D
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3043
Practice Address - Country:US
Practice Address - Phone:626-966-1577
Practice Address - Fax:626-331-4529
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program