Healthcare Provider Details

I. General information

NPI: 1376589077
Provider Name (Legal Business Name): CRAIG RANDOLPH SOLEIM NAVY IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 CLARK ST NAVAL SUBMARINE SUPPORT COMMAND MEDICAL
PEARL HARBOR HI
96860-4652
US

IV. Provider business mailing address

2262 WAIKAHE CT
PEARL CITY HI
96782-3478
US

V. Phone/Fax

Practice location:
  • Phone: 808-473-2899
  • Fax: 808-473-3109
Mailing address:
  • Phone: 808-489-9673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: