Provider Demographics
NPI:1780725598
Name:AGUANNO, ROBERT MATTHEW (CNIM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MATTHEW
Last Name:AGUANNO
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 CAMBRIDGE CIRCUS
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581
Mailing Address - Country:US
Mailing Address - Phone:281-313-1355
Mailing Address - Fax:281-313-1356
Practice Address - Street 1:1108 SOLDIERS FIELD DR
Practice Address - Street 2:#234
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4053
Practice Address - Country:US
Practice Address - Phone:281-313-1355
Practice Address - Fax:281-313-1356
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNIM 1113246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic