Healthcare Provider Details

I. General information

NPI: 1558418558
Provider Name (Legal Business Name): DOMINADOR BALINBIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1034 PAIWA PL
WAIPAHU HI
96797-3648
US

IV. Provider business mailing address

94-1034 PAIWA PL
WAIPAHU HI
96797-3648
US

V. Phone/Fax

Practice location:
  • Phone: 808-677-1022
  • Fax:
Mailing address:
  • Phone: 808-677-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number1795C
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: