Individual
BLAKE AARON GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2540 CHARLESTON ST, OAKLAND, CA 94602-2508
(510) 531-7551
Mailing address
2540 CHARLESTON ST, OAKLAND, CA 94602-2508
(510) 531-7551
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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