Healthcare Provider Details

I. General information

NPI: 1750531083
Provider Name (Legal Business Name): DANNY MICHAEL RUDOMETKIN MAEC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-169 WAILAWA ST
MILILANI HI
96789-3205
US

IV. Provider business mailing address

95-169 WAILAWA ST
MILILANI HI
96789-3205
US

V. Phone/Fax

Practice location:
  • Phone: 808-306-6665
  • Fax:
Mailing address:
  • Phone: 808-306-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number110188
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: