Provider Demographics
NPI:1881286151
Name:BIBLE, WILLIE III
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:
Last Name:BIBLE
Suffix:III
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 1:2745 OWENS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3013
Mailing Address - Country:US
Mailing Address - Phone:323-440-0429
Mailing Address - Fax:
Practice Address - Street 1:2745 OWENS ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3013
Practice Address - Country:US
Practice Address - Phone:323-440-0429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health