Individual
DEYANIRA G GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16254 BRIDGTON CIR, RIVERSIDE, CA 92503-5978
(951) 801-0594
Mailing address
16254 BRIDGTON CIR, RIVERSIDE, CA 92503-5978
(951) 801-0594
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95027062
CA
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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