Most Relevant Information
Provider Data
| NPI Number: | 1003434929 |
| Provider Name: | IKEESHYA GIBSON |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/07/2020 |
| Last Updated: | 07/07/2020 |
Provider Practice Location
391 JENKS DR
CORONA
CA
928802518
Practice Location Phone/Fax
| Phone: | 9492818725 |
| Fax: |
Provider Mailing Location
11424 WINTER PL
ADELANTO
CA
923016025
Provider Mailing Phone/Fax
| Phone: | 6029310533 |
| Fax: |