MEDICARE: CHRISTINE KAY GAVINO D.O.

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	207Q00000X	Family Medicine Physician	Q6192	TX

General Provider Information

NPI Number	:	1558709881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE KAY GAVINO D.O.

Provider Business Mailing Address
First Line	:	2912 VILLAGE BROOK LN
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-3484
Country	:	US
Telephone Number	:	832-276-4079
Fax Number	:

Provider Business Practice Location Address
First Line	:	6912 FM 1488 RD STE A
Second Line	:
City	:	MAGNOLIA
State	:	TX
Zip	:	77354-1527
Country	:	US
Telephone Number	:	281-356-1945
Fax Number	:	281-356-1978

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

Provider Enumeration Date	:	06/09/2013
Last Update Date	:	07/14/2016

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