MEDICARE: MR. VINCENT DAQUILA GUBATANGA NP

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	363LG0600X	Gerontology Nurse Practitioner	1057440	TX

General Provider Information

NPI Number	:	1295607125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VINCENT DAQUILA GUBATANGA NP

Provider Business Mailing Address
First Line	:	4645 SWEETWATER BLVD STE 200
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3016
Country	:	US
Telephone Number	:	713-684-9895
Fax Number	:

Provider Business Practice Location Address
First Line	:	4645 SWEETWATER BLVD STE 200
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3016
Country	:	US
Telephone Number	:	713-684-9895
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2025
Last Update Date	:	01/06/2026

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