Provider Demographics
NPI:1841068012
Name:GAINES, ANTOINETTE
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 SOWDEN RD
Mailing Address - Street 2:STE B #895974
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080
Mailing Address - Country:US
Mailing Address - Phone:281-318-8053
Mailing Address - Fax:
Practice Address - Street 1:21717 INVERNESS FOREST BLVD APT 2305
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1352
Practice Address - Country:US
Practice Address - Phone:281-318-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAEA04DAED1E1DEF2246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy