Healthcare Provider Details

I. General information

NPI: 1932448719
Provider Name (Legal Business Name): RANDY COLLINS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 PAA ST STE 4
HONOLULU HI
96819-4429
US

IV. Provider business mailing address

2810 PAA ST STE 4
HONOLULU HI
96819-4429
US

V. Phone/Fax

Practice location:
  • Phone: 808-839-7474
  • Fax: 808-833-4086
Mailing address:
  • Phone: 808-839-7474
  • Fax: 808-833-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number173
License Number StateHI

VIII. Authorized Official

Name: DR. RANDY RAY COLLINS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 808-839-7474