Doctor Name: | JACK GUILLERMO SIBAL |
NPI Number: | 1962482042 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 495577 |
Business Practice Address: | 1001 S. Seaside Ave; Bldg 23 Isc San Pedro San Pedro, CA - 90731 |
Business Phone Number: | 3107327500 |
Business Fax Number: | 3107327519 |
Mailing Address: | 6122 Marvin St, NORTH LAS VEGAS |
State: | NV |
Postal Code: | 890310646 |
Phone Number: | 7026498570 |
Fax Number: | 3107327500 |
NPI Enumeration Date: | 01/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163W00000X |
License Number: | 495577 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | CA |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N. |