MEDICARE: GINO CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY-475	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548527617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GINO CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 25972
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96825-0972
Country	:	US
Telephone Number	:	808-528-1184
Fax Number	:	808-528-1184

Provider Business Practice Location Address
First Line	:	1154 FORT STREET MALL STE 206
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2712
Country	:	US
Telephone Number	:	808-528-1184
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. ANTONIO GINO
Credential	:	PH.D.
Telephone Number	:	808-383-9834

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	04/13/2012

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Directions to “GINO CLINIC ” Practice Location

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