Basic Information
| Provider Information | |||||||||
| NPI: | 1346556024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILBREATH | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | RCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6480 KATHERINE RD | ||||||||
| Address2: | SPACE 76 | ||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930636401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052319986 | ||||||||
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| Practice Location | |||||||||
| Address1: | 994 GOLDEN CREST AVE | ||||||||
| Address2: | |||||||||
| City: | NEWBURY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913205814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054984344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2010 | ||||||||
| LastUpdateDate: | 08/19/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227800000X | RCP1926 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified |
No ID Information.