Healthcare Provider Details

I. General information

NPI: 1821683665
Provider Name (Legal Business Name): VICTOR A QUIROS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92-9024 TREE FERN LN
OCEAN VIEW HI
96704
US

IV. Provider business mailing address

92-9024 TREE FERN LN
OCEAN VIEW HI
96704
US

V. Phone/Fax

Practice location:
  • Phone: 808-990-4302
  • Fax:
Mailing address:
  • Phone: 808-990-4302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH00598816
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: