Provider Demographics
NPI:1154652303
Name:GIBBS, ALBERT RANDOLPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:RANDOLPH
Last Name:GIBBS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 LOTUS ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-2522
Mailing Address - Country:US
Mailing Address - Phone:310-559-5233
Mailing Address - Fax:310-763-0372
Practice Address - Street 1:3440 MOTOR AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4793
Practice Address - Country:US
Practice Address - Phone:310-559-5233
Practice Address - Fax:310-763-0372
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5390103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist