MEDICARE: ARIS GOINGCO QUIAMBAO

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	225200000X	Physical Therapy Assistant	2306602908	VA

General Provider Information

NPI Number	:	1538463955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIS GOINGCO QUIAMBAO

Provider Business Mailing Address
First Line	:	1624 CASTLEFIELD RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-5478
Country	:	US
Telephone Number	:	757-416-1106
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 CASTLEFIELD RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-5478
Country	:	US
Telephone Number	:	757-416-1106
Fax Number	:

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

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	01/05/2011

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Directions to “ ARIS GOINGCO QUIAMBAO ” Practice Location

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