Provider Demographics
NPI:1275961385
Name:GAVINO T. VINZONS M.D, INC
Entity Type:Organization
Organization Name:GAVINO T. VINZONS M.D, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GAVINO
Authorized Official - Middle Name:T
Authorized Official - Last Name:VINZONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-842-7146
Mailing Address - Street 1:2055 N. KING ST. STE 102
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:808-842-7146
Mailing Address - Fax:808-843-2638
Practice Address - Street 1:2055 N. KING ST. STE 102
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-842-7146
Practice Address - Fax:808-843-2638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAVINO T. VINZONS M.D., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC98971Medicare UPIN