Healthcare Provider Details

I. General information

NPI: 1043704935
Provider Name (Legal Business Name): AMADA LUZ GUZMAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5-4280 KUHIO HWY STE B206
PRINCEVILLE HI
96722-5451
US

IV. Provider business mailing address

PO BOX 223489
PRINCEVILLE HI
96722-3489
US

V. Phone/Fax

Practice location:
  • Phone: 808-826-7000
  • Fax: 808-826-7600
Mailing address:
  • Phone: 916-969-0754
  • Fax: 808-826-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-1398
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: