Healthcare Provider Details

I. General information

NPI: 1952873325
Provider Name (Legal Business Name): VINCENT SANEKANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-184 HUALALAI RD # 302
KAILUA KONA HI
96740-1719
US

IV. Provider business mailing address

79-7199 MAMALAHOA HWY A-201
KAILUA-KONA HI
96740
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-0111
  • Fax: 808-365-5811
Mailing address:
  • Phone: 808-443-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPTA-451
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: