Provider Demographics
NPI:1285658690
Name:GUMBS, JOSLYN LOIS (MD)
Entity type:Individual
Prefix:
First Name:JOSLYN
Middle Name:LOIS
Last Name:GUMBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 LA LOMA ROAD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2158
Mailing Address - Country:US
Mailing Address - Phone:323-385-8662
Mailing Address - Fax:323-257-1314
Practice Address - Street 1:1300 N VERMONT AVE STE 804
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6091
Practice Address - Country:US
Practice Address - Phone:323-257-1814
Practice Address - Fax:323-257-1314
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87245207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A872450Medicaid
CA00A872450OtherBLUE SHIELD
CAW12043AMedicare PIN
CABU436AMedicare PIN