Healthcare Provider Details

I. General information

NPI: 1417969627
Provider Name (Legal Business Name): REDENTOR C ROJALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N KING ST SUITE 106
HONOLULU HI
96819-3479
US

IV. Provider business mailing address

2055 N KING ST SUITE 106
HONOLULU HI
96819-3479
US

V. Phone/Fax

Practice location:
  • Phone: 808-842-9113
  • Fax: 808-843-1642
Mailing address:
  • Phone: 808-842-9113
  • Fax: 808-843-1642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number5684
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: