Provider Demographics
NPI:1144953878
Name:GIBBS, AMBER LYNETTE (MT, CNA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNETTE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24091 FIR AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3141
Mailing Address - Country:US
Mailing Address - Phone:951-415-1386
Mailing Address - Fax:
Practice Address - Street 1:24091 FIR AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3141
Practice Address - Country:US
Practice Address - Phone:951-415-1386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57753225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist