Healthcare Provider Details

I. General information

NPI: 1649639915
Provider Name (Legal Business Name): CARDIOPULMONARY DIAGNOSTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 N KING ST # A2
HONOLULU HI
96819-3481
US

IV. Provider business mailing address

2070 N. KING STREET A2
HONOLULU HI
96819-3458
US

V. Phone/Fax

Practice location:
  • Phone: 808-678-1422
  • Fax: 808-678-2278
Mailing address:
  • Phone: 808-678-1422
  • Fax: 808-678-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberH54132
License Number StateHI

VIII. Authorized Official

Name: MS. RIDA T.R. CABANILLA
Title or Position: PRESIDENT
Credential: RN
Phone: 808-841-2778