Healthcare Provider Details

I. General information

NPI: 1114162518
Provider Name (Legal Business Name): LGD ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2008
Last Update Date: 12/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 ALA LELEU ST
HONOLULU HI
96818-1516
US

IV. Provider business mailing address

PO BOX 971617
WAIPAHU HI
96797-8207
US

V. Phone/Fax

Practice location:
  • Phone: 808-839-3091
  • Fax:
Mailing address:
  • Phone: 808-839-3091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberW3059479201
License Number StateHI

VIII. Authorized Official

Name: MR. CONSTANTE ALBANO DOMINGO
Title or Position: OWNER
Credential:
Phone: 808-839-3091