Provider Demographics
NPI:1710511753
Name:GULF COAST NEUROPSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:GULF COAST NEUROPSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR, NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ZGALJARDIC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:409-789-1339
Mailing Address - Street 1:1110 NASA PKWY STE 108C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3351
Mailing Address - Country:US
Mailing Address - Phone:409-789-1339
Mailing Address - Fax:713-481-6304
Practice Address - Street 1:1110 NASA PKWY STE 108C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3351
Practice Address - Country:US
Practice Address - Phone:409-789-1339
Practice Address - Fax:713-481-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty