DAJUAN GIBSON NPI 1255524385

NPI Information

NPI: 1255524385
Provider Name: DAJUAN GIBSON
Classification: Rehabilitation Practitioner - 225400000X
Entity Type: Individual
Address:
600 ST PAUL AVE
SUITE 100
LOS ANGELES, CA
ZIP 90017
Phone: (213) 482-6400
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Dajuan Gibson is a rehabilitation practitioner in Los Angeles, CA. The provider is a health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. Dajuan Gibson NPI is 1255524385. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

600 ST PAUL AVE
SUITE 100
LOS ANGELES, CA
ZIP 90017-038
Phone: (213) 482-6400

The enumeration date for this NPI number is 8/22/2007 and was last updated on 5/15/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	171M00000X	Case Manager/Care Coordinator				No
2	225400000X	Rehabilitation Practitioner				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	1841342318	MEDICAID	CALIFORNIA
2	1265520183	MEDICAID	CALIFORNIA
3	1306922554	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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