Provider Demographics
NPI:1508903774
Name:GAVIOLA, ALAIN R
Entity Type:Individual
Prefix:MR
First Name:ALAIN
Middle Name:R
Last Name:GAVIOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S GESSNER RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5100
Mailing Address - Country:US
Mailing Address - Phone:713-781-2040
Mailing Address - Fax:713-782-1136
Practice Address - Street 1:3300 S GESSNER RD
Practice Address - Street 2:SUITE 125
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5100
Practice Address - Country:US
Practice Address - Phone:713-781-2040
Practice Address - Fax:713-782-1136
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010120251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010120Medicare ID - Type Unspecified