Healthcare Provider Details

I. General information

NPI: 1154556280
Provider Name (Legal Business Name): RODNEY VALDECANAS ACASIO IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 WORCHESTER AVE BLDG 45
HICKAM AFB HI
96853-5530
US

IV. Provider business mailing address

111 KOPIKO ST.
HONOLULU HI
96818-5429
US

V. Phone/Fax

Practice location:
  • Phone: 808-474-4959
  • Fax: 808-474-4880
Mailing address:
  • Phone: 808-474-4959
  • Fax: 808-474-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: