Healthcare Provider Details

I. General information

NPI: 1770082281
Provider Name (Legal Business Name): MR. ROBERT DENNIS WATSON-CORREA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 ALOALO ST
HILO HI
96720-5728
US

IV. Provider business mailing address

79 ALOALO ST
HILO HI
96720-5728
US

V. Phone/Fax

Practice location:
  • Phone: 808-443-9900
  • Fax: 808-769-4975
Mailing address:
  • Phone: 808-443-9900
  • Fax: 808-769-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: