Provider Demographics
NPI:1346396272
Name:GIBSON, SEANNE CECELIA (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:SEANNE
Middle Name:CECELIA
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:MS
Other - First Name:SEANNIE
Other - Middle Name:CECELIA
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:496 RAINBOW AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3952
Mailing Address - Country:US
Mailing Address - Phone:323-221-7822
Mailing Address - Fax:323-221-8889
Practice Address - Street 1:496 RAINBOW AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3952
Practice Address - Country:US
Practice Address - Phone:323-221-7822
Practice Address - Fax:323-221-8889
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM 171176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife