Provider Demographics
NPI:1912353343
Name:GIL AGOSTINHO, LUIS PEDRO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:PEDRO
Last Name:GIL AGOSTINHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4714
Mailing Address - Country:US
Mailing Address - Phone:701-781-0510
Mailing Address - Fax:
Practice Address - Street 1:313 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4714
Practice Address - Country:US
Practice Address - Phone:701-781-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDGIL-70-9863172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver