Kenny Gaston

NPI #1205302973 in Mitchellville, Maryland

Provider Information

NPI Number: 1205302973
Entity Type: Individual
Name: Kenny Gaston
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Student in an Organized Health Care Education/Training Program
Enumeration Date: Oct 19, 2018
Last Updated: Oct 19, 2018

Practice Location

Address: 12158 CENTRAL AVE
City: Mitchellville
State: Maryland
ZIP Code: 20721-1932
Phone: (301) 430-2750

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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