Provider Demographics
NPI:1881788693
Name:SCOTT-GIBSON, HELEN L (PA)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:L
Last Name:SCOTT-GIBSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:L
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3628 E IMPERIAL HWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3628 E IMPERIAL HWY
Practice Address - Street 2:SUITE 302
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2643
Practice Address - Country:US
Practice Address - Phone:310-631-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 10742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S71798Medicare UPIN