Healthcare Provider Details

I. General information

NPI: 1114398062
Provider Name (Legal Business Name): JEFFREY RAYMOND HUGHES EMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47666 ZUNIC DR
FREMONT CA
94539-7552
US

IV. Provider business mailing address

47666 ZUNIC DR
FREMONT CA
94539-7552
US

V. Phone/Fax

Practice location:
  • Phone: 808-255-6005
  • Fax:
Mailing address:
  • Phone: 808-255-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberEMT-P1771
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: