Provider Demographics
NPI:1285037531
Name:GIBBONS, KEVIN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:GIBBONS
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 1:201 3RD ST
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3143
Mailing Address - Country:US
Mailing Address - Phone:415-615-5604
Mailing Address - Fax:415-615-5608
Practice Address - Street 1:201 3RD ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3143
Practice Address - Country:US
Practice Address - Phone:415-615-5604
Practice Address - Fax:415-615-5608
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator