Healthcare Provider Details

I. General information

NPI: 1033351812
Provider Name (Legal Business Name): HARRY GINO DESALVATORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 6TH AVE N
NASHVILLE TN
37208-2650
US

IV. Provider business mailing address

1101 6TH AVE N
NASHVILLE TN
37208-2650
US

V. Phone/Fax

Practice location:
  • Phone: 615-460-4128
  • Fax: 615-460-4189
Mailing address:
  • Phone: 615-460-4128
  • Fax: 615-460-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: