Provider Demographics
NPI:1588617492
Name:VINZONS, GAVINO TAGALA (MD)
Entity Type:Individual
Prefix:MR
First Name:GAVINO
Middle Name:TAGALA
Last Name:VINZONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 NORTH KING STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:808-842-7126
Mailing Address - Fax:808-843-2638
Practice Address - Street 1:2055 NORTH KING STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-842-7126
Practice Address - Fax:808-843-2638
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02677301Medicaid
HIH0000BDSPVMedicare ID - Type Unspecified
C98971Medicare UPIN