Healthcare Provider Details

I. General information

NPI: 1164865572
Provider Name (Legal Business Name): VIGILANT ANESTHETIX, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL STREET OPERATING ROOMS, 3RD FLOOR,
HONOLULU HI
96813
US

IV. Provider business mailing address

P O BOX 88169
HONOLULU HI
96815-9998
US

V. Phone/Fax

Practice location:
  • Phone: 808-541-7888
  • Fax:
Mailing address:
  • Phone: 808-541-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number15648
License Number StateHI

VIII. Authorized Official

Name: DR. BARUGUR SUBRAMANIAN RAVI
Title or Position: CEO
Credential: MD
Phone: 808-541-7888