Provider Demographics
NPI:1366499253
Name:TAINO, GEORGES CUSTODIO (IDC)
Entity type:Individual
Prefix:MR
First Name:GEORGES
Middle Name:CUSTODIO
Last Name:TAINO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 NW WHISPER ST
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8338
Mailing Address - Country:US
Mailing Address - Phone:360-698-2773
Mailing Address - Fax:
Practice Address - Street 1:1400 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98314-6001
Practice Address - Country:US
Practice Address - Phone:360-476-4023
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman