Active NPI
Leslie Lawrence Gibson III
- Pharmacist
- Redlands, CA
National Provider Identifier
1194293589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 35410
- Practice address
- 1125 Via Ravenna
Redlands, CA 92374-3984 - Phone
- (909) 528-0096
- NPI assigned
- Nov 5, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 35410 | CA | Primary |
Addresses
Primary practice location
1125 Via Ravenna
Redlands, CA 92374-3984
Mailing address
1125 Via Ravenna
Redlands, CA 92374-3984
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35410 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541376000000",
"number": "1194293589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1125 VIA RAVENNA",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923743984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1125 VIA RAVENNA",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923743984",
"telephone_number": "909-528-0096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "LESLIE",
"middle_name": "LAWRENCE",
"name_suffix": "III",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-11-05",
"last_updated": "2018-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "35410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.