Healthcare Provider Details

I. General information

NPI: 1417055583
Provider Name (Legal Business Name): ALFRED S LOSBANOS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BUDDY LOSBANOS PT

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-565 KAMEHAMEHA HWY
KAHUKU HI
96731-2202
US

IV. Provider business mailing address

56-565 KAMEHAMEHA HWY
KAHUKU HI
96731-2202
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-9885
  • Fax: 808-293-1999
Mailing address:
  • Phone: 808-293-9885
  • Fax: 808-293-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 1401
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: