Provider Demographics
NPI:1508672395
Name:GIBER SEGEV, KEREN
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:GIBER SEGEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 W CANARY WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-8015
Mailing Address - Country:US
Mailing Address - Phone:480-273-5359
Mailing Address - Fax:
Practice Address - Street 1:1795 W CANARY WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-8015
Practice Address - Country:US
Practice Address - Phone:480-273-5359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-21671174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN