Healthcare Provider Details

I. General information

NPI: 1811307093
Provider Name (Legal Business Name): ASENTRA MARKETING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 BOUGAINVILLE DR
HONOLULU HI
96818-3179
US

IV. Provider business mailing address

4725 BOUGAINVILLE DR
HONOLULU HI
96818-3179
US

V. Phone/Fax

Practice location:
  • Phone: 203-650-6922
  • Fax:
Mailing address:
  • Phone: 203-650-6922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVE GRUBLER
Title or Position: CEO
Credential: CEO
Phone: 203-650-6922