Individual
DAJUAN GIBSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 ST PAUL AVE, SUITE 100, LOS ANGELES, CA 90017-2038
(213) 482-6400
Mailing address
600 ST PAUL AVE, SUITE 100, LOS ANGELES, CA 90017-2038
(213) 482-6400
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265520183
—
CA
05
—
1306922554
—
CA
05
—
1841342318
—
CA
Enumeration date
08/22/2007
Last updated
05/15/2015
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