Provider Demographics
NPI:1811632409
Name:GIBBY, DEVYN (DO)
Entity type:Individual
Prefix:
First Name:DEVYN
Middle Name:
Last Name:GIBBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 AVENIDA PICO STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3908
Mailing Address - Country:US
Mailing Address - Phone:949-557-0820
Mailing Address - Fax:949-557-0821
Practice Address - Street 1:993 AVENIDA PICO STE 110
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-3908
Practice Address - Country:US
Practice Address - Phone:949-557-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A24264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty