Healthcare Provider Details

I. General information

NPI: 1790910271
Provider Name (Legal Business Name): MENTOB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-6082 ALII DR STE 9
KAILUA KONA HI
96740-4303
US

IV. Provider business mailing address

75-6082 ALII DR STE 9
KAILUA KONA HI
96740-4303
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-0084
  • Fax: 808-329-0084
Mailing address:
  • Phone: 808-329-0084
  • Fax: 808-329-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number197
License Number StateHI

VIII. Authorized Official

Name: MARY J THOMPSON
Title or Position: OWNER
Credential:
Phone: 808-329-0084