Provider Demographics
NPI:1750778478
Name:GIBBS, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GIBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 SEPULVEDA AVE APT 28
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-1326
Mailing Address - Country:US
Mailing Address - Phone:909-913-1332
Mailing Address - Fax:
Practice Address - Street 1:1501 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7725
Practice Address - Country:US
Practice Address - Phone:909-877-4889
Practice Address - Fax:909-877-4898
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist