Healthcare Provider Details

I. General information

NPI: 1770994014
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALISTS OF HAWAII, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-128 AIEA HEIGHTS DR STE 206
AIEA HI
96701-3932
US

IV. Provider business mailing address

99-128 AIEA HEIGHTS DR STE 206
AIEA HI
96701-3932
US

V. Phone/Fax

Practice location:
  • Phone: 808-250-3216
  • Fax: 808-487-6906
Mailing address:
  • Phone: 808-250-3216
  • Fax: 808-487-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES MARK SIMMONS
Title or Position: OWNER
Credential: RVT
Phone: 808-250-3216