1932117652 NPI number — VINCENT JOHN GONINO D.O.

Table of content: VINCENT JOHN GONINO D.O. (NPI 1932117652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932117652 NPI number — VINCENT JOHN GONINO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONINO
Provider First Name:
VINCENT
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONINO
Provider Other First Name:
V.
Provider Other Middle Name:
JOHN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932117652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6720 HORIZON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEATH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75032-6273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-402-2800
Provider Business Mailing Address Fax Number:
469-402-0348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6720 HORIZON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEATH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75032-6273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-402-2800
Provider Business Practice Location Address Fax Number:
469-402-0348
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  J2032 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 123661405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00U71S . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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