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1154983104
JOSHUA LOGAN GIBSON
STOCKTON, CA
NPI
1154983104
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2019-06-30
Last Update Date
2019-06-30
Business Address
JOSHUA LOGAN GIBSON
405 E PINE ST
STOCKTON, CA 95204-5522
Phone number: 209-464-5519
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Mailing Address
JOSHUA LOGAN GIBSON
3601 PACIFIC AVE
STOCKTON, CA 95211-0110
Phone number:
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