Healthcare Provider Details

I. General information

NPI: 1154423424
Provider Name (Legal Business Name): SANDRA L GAVIOLA RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CENTER 1700 S. LINCOLN AVENUE
LEBANON PA
17042
US

IV. Provider business mailing address

27 ANVIL MILL QUARTERS S. LANCASTER STREET
ANNVILLE PA
17003-1854
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-6621
  • Fax: 717-228-5950
Mailing address:
  • Phone: 412-527-9321
  • Fax: 717-228-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberYO000566L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: