Provider Demographics
NPI:1316458847
Name:PRIMO, VINCE
Entity type:Individual
Prefix:
First Name:VINCE
Middle Name:
Last Name:PRIMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22315 GOSLING RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-4409
Mailing Address - Country:US
Mailing Address - Phone:281-466-2618
Mailing Address - Fax:281-466-2893
Practice Address - Street 1:22315 GOSLING RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-4409
Practice Address - Country:US
Practice Address - Phone:281-466-2618
Practice Address - Fax:281-466-2893
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3-20562-7504-6171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX47-2971977OtherWE SELL THERAPUTIC HOT TUBS AND SWIM SPAS