Healthcare Provider Details

I. General information

NPI: 1851448187
Provider Name (Legal Business Name): LSSB CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 LOIO PLACE
PAIA HI
96779-1481
US

IV. Provider business mailing address

PO BOX 791481
PAIA HI
96779-1481
US

V. Phone/Fax

Practice location:
  • Phone: 808-283-8449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SCOTT SHAPIRO
Title or Position: PRESIDENT
Credential:
Phone: 808-283-8449