Healthcare Provider Details

I. General information

NPI: 1376472969
Provider Name (Legal Business Name): PETER GORGUI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-820 MOANALUA RD SPC 5
AIEA HI
96701-5200
US

IV. Provider business mailing address

98-820 MOANALUA RD SPC 5
AIEA HI
96701-5200
US

V. Phone/Fax

Practice location:
  • Phone: 808-845-6080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: