Basic Information
| Provider Information | |||||||||
| NPI: | 1679768865 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAVINO | ||||||||
| FirstName: | MA HAZEL LYN | ||||||||
| MiddleName: | GUTIERREZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7211 W DESCHUTES AVE | ||||||||
| Address2: | STE E | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993367715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095861157 | ||||||||
| FaxNumber: | 5095824189 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 S AUBURN ST | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993365665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097371878 | ||||||||
| FaxNumber: | 5097371879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 03/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301090727 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.