Individual
LISA ANN GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD
Contact information
Practice address
11 QUEBRADA, IRVINE, CA 92620-1867
(714) 832-2388
Mailing address
11 QUEBRADA, IRVINE, CA 92620-1867
(714) 832-2388
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
521019
CO
Other
Enumeration date
08/07/2013
Last updated
08/07/2013
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