Provider Demographics
NPI:1649839598
Name:VINT, TAAVI MATIAS (PA-C)
Entity type:Individual
Prefix:
First Name:TAAVI
Middle Name:MATIAS
Last Name:VINT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 WASHINGTON AVE APT 811
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-4823
Mailing Address - Country:US
Mailing Address - Phone:734-620-7283
Mailing Address - Fax:
Practice Address - Street 1:1919 NORTH LOOP W STE 280
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1368
Practice Address - Country:US
Practice Address - Phone:832-930-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009217363A00000X
TXPA17096363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant