Basic Information
| Provider Information | |||||||||
| NPI: | 1528275310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUMELBAUGH | ||||||||
| FirstName: | GIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2294 | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902672294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107026305 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1403 LOMITA BLVD | ||||||||
| Address2: | 2ND FLOOR, FAMILY MEDICINE CLINIC | ||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907102076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105347600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A95749 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.