Provider Demographics
NPI:1316482409
Name:GAIEB, DRISS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DRISS
Middle Name:
Last Name:GAIEB
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-1039
Mailing Address - Country:US
Mailing Address - Phone:562-912-0456
Mailing Address - Fax:
Practice Address - Street 1:16 THIRD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-1039
Practice Address - Country:US
Practice Address - Phone:619-425-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH5921183500000X
CA80282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist