Provider Demographics
NPI:1558384321
Name:GIBBS, JOSEPH WARREN (LPT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WARREN
Last Name:GIBBS
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8036 CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5243
Mailing Address - Country:US
Mailing Address - Phone:916-207-2795
Mailing Address - Fax:
Practice Address - Street 1:8036 CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5243
Practice Address - Country:US
Practice Address - Phone:916-207-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22640167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician