Provider Demographics
NPI:1346398765
Name:GUBERNICK, HAROLD REY (DC)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:REY
Last Name:GUBERNICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2504
Mailing Address - Country:US
Mailing Address - Phone:951-235-7121
Mailing Address - Fax:951-755-0395
Practice Address - Street 1:3011 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2504
Practice Address - Country:US
Practice Address - Phone:951-235-7121
Practice Address - Fax:951-755-0395
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor