Provider Demographics
NPI:1851802581
Name:GIBSON, TERESA ANN (CERTIFIED DOULA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23930 OCEAN AVE APT 269
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5874
Mailing Address - Country:US
Mailing Address - Phone:310-592-9148
Mailing Address - Fax:
Practice Address - Street 1:23930 OCEAN AVE APT 269
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5874
Practice Address - Country:US
Practice Address - Phone:310-592-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherSOCIAL SECURITY