Healthcare Provider Details

I. General information

NPI: 1396660635
Provider Name (Legal Business Name): DISHON GONZALEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ALOHA TOWER DR
HONOLULU HI
96813-4800
US

IV. Provider business mailing address

PO BOX 4531
KANEOHE HI
96744-8531
US

V. Phone/Fax

Practice location:
  • Phone: 808-544-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN-5116
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: