MEDICARE: GORIOLA TONY SHOTOMIWA

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	332B00000X	Durable Medical Equipment & Medical Supplies	36239122	TX
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	36239122	TX
3	332BX2000X	Oxygen Equipment & Supplies (DME)	36239122	TX

General Provider Information

NPI Number	:	1629314489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORIOLA TONY SHOTOMIWA

Provider Business Mailing Address
First Line	:	6814 STABLETON LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-2054
Country	:	US
Telephone Number	:	713-542-7438
Fax Number	:

Provider Business Practice Location Address
First Line	:	6814 STABLETON LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-2054
Country	:	US
Telephone Number	:	713-542-7438
Fax Number	:

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

Provider Enumeration Date	:	12/26/2012
Last Update Date	:	12/26/2012

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Directions to “ GORIOLA TONY SHOTOMIWA ” Practice Location

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