Healthcare Provider Details

I. General information

NPI: 1396313763
Provider Name (Legal Business Name): BENJAMIN HUBLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 MAKALAPA RD
JOINT BASE PEARL HARBOR-HICKAM HI
96853
US

IV. Provider business mailing address

91-1383 KAIOKIA ST UNIT 2004
EWA BEACH HI
96706-6513
US

V. Phone/Fax

Practice location:
  • Phone: 808-473-1880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: