Provider Demographics
NPI:1346556024
Name:GILBREATH, LISA G (RCP)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:G
Last Name:GILBREATH
Suffix:
Gender:F
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 KATHERINE RD
Mailing Address - Street 2:SPACE 76
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-6401
Mailing Address - Country:US
Mailing Address - Phone:805-231-9986
Mailing Address - Fax:
Practice Address - Street 1:994 GOLDEN CREST AVE
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-5814
Practice Address - Country:US
Practice Address - Phone:805-498-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARCP1926227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified