Provider Demographics
NPI:1235416629
Name:NASCIMENTO, PAULO (HIS CPOP)
Entity Type:Individual
Prefix:
First Name:PAULO
Middle Name:
Last Name:NASCIMENTO
Suffix:
Gender:M
Credentials:HIS CPOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-3641
Mailing Address - Country:US
Mailing Address - Phone:712-262-4121
Mailing Address - Fax:712-262-4124
Practice Address - Street 1:920 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3641
Practice Address - Country:US
Practice Address - Phone:712-262-4121
Practice Address - Fax:712-262-4124
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1032237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist