Provider Demographics
NPI:1669845442
Name:ALLERGY AND ASTHMA SPECIALTY CENTER INC
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA SPECIALTY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-229-4053
Mailing Address - Street 1:9220 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8551
Mailing Address - Country:US
Mailing Address - Phone:909-944-9058
Mailing Address - Fax:
Practice Address - Street 1:9220 HAVEN AVE
Practice Address - Street 2:STE 101
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8551
Practice Address - Country:US
Practice Address - Phone:909-944-9058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9958207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty