Healthcare Provider Details

I. General information

NPI: 1780725598
Provider Name (Legal Business Name): ROBERT MATTHEW AGUANNO CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 SOLDIERS FIELD DR #234
SUGAR LAND TX
77479-4053
US

IV. Provider business mailing address

2902 CAMBRIDGE CIRCUS
PEARLAND TX
77581
US

V. Phone/Fax

Practice location:
  • Phone: 281-313-1355
  • Fax: 281-313-1356
Mailing address:
  • Phone: 281-313-1355
  • Fax: 281-313-1356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License NumberCNIM 1113
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: