Healthcare Provider Details

I. General information

NPI: 1639953466
Provider Name (Legal Business Name): VICTOR RIVEIRO CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 ULUNIU ST
KAILUA HI
96734-2519
US

IV. Provider business mailing address

46-344 NAHEWAI ST
KANEOHE HI
96744-4151
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-4321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT-5768
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: