Healthcare Provider Details

I. General information

NPI: 1700078094
Provider Name (Legal Business Name): AL'S VINYL REPAIR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1247 KAAHUMANU ST SUITE #117B
AIEA HI
96701-5311
US

IV. Provider business mailing address

3221 WAIALAE AVE STE #345
HONOLULU HI
96816-5842
US

V. Phone/Fax

Practice location:
  • Phone: 808-488-9987
  • Fax: 808-488-0623
Mailing address:
  • Phone: 808-732-5223
  • Fax: 808-735-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number101
License Number StateHI

VIII. Authorized Official

Name: MRS. CARLEEN JALE
Title or Position: VICE PRESIDENT
Credential:
Phone: 808-732-5223