Provider Demographics
NPI:1891089298
Name:GIBBENS, JACOB (JAKE GIBBENS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:GIBBENS
Suffix:
Gender:M
Credentials:JAKE GIBBENS
Other - Prefix:DR
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:GIBBENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:710 LAWRENCE EXPY DEPT 340
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5173
Mailing Address - Country:US
Mailing Address - Phone:408-851-3035
Mailing Address - Fax:408-851-9574
Practice Address - Street 1:710 LAWRENCE EXPY DEPT 340
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-851-3570
Practice Address - Fax:408-851-3574
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA155597207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine