Healthcare Provider Details

I. General information

NPI: 1144375684
Provider Name (Legal Business Name): RICHARD RODRIGUE GINGRAS CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CYPRESS WAY E STE 60
NAPLES FL
34110-9275
US

IV. Provider business mailing address

28025 EAGLE RAY CT
BONITA SPRINGS FL
34135-8402
US

V. Phone/Fax

Practice location:
  • Phone: 239-307-5520
  • Fax:
Mailing address:
  • Phone: 336-414-5828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: