Healthcare Provider Details

I. General information

NPI: 1245652783
Provider Name (Legal Business Name): CARMELITA D. CASIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1020 HAPAPA ST
WAIPAHU HI
96797-3735
US

IV. Provider business mailing address

94-1020 HAPAPA ST
WAIPAHU HI
96797-3735
US

V. Phone/Fax

Practice location:
  • Phone: 808-671-0756
  • Fax: 808-671-0756
Mailing address:
  • Phone: 808-671-0756
  • Fax: 808-671-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number3104A0625X
License Number StateHI

VIII. Authorized Official

Name: CARMELITA DAGUIO CASIL
Title or Position: OWNER
Credential:
Phone: 808-671-0756