Healthcare Provider Details

I. General information

NPI: 1073682415
Provider Name (Legal Business Name): KEITH M HORINOUCHI M.N.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 CHALAN SAN ANTONIO 226 C/D CHALAN SAN ANTONIO
TAMUNING GU
96913
US

IV. Provider business mailing address

226 C/D CHALAN SAN ANTONIO AMPAROS BUSINESS CENTER
TAMUNING GU
96913
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-9333
  • Fax: 671-646-9334
Mailing address:
  • Phone: 671-646-9333
  • Fax: 671-646-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNUT000002
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: