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General NPI Number Information
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NPI Number | 1114162518
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Entity Type | Organization
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Legal Business Name | LGD ENTERPRISE
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Dates
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Enumeration Date | 12/14/2008
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Last Update Date | 12/14/2008
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Provider Practice Location Address
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Address Line | 1419 ALA LELEU ST
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City | HONOLULU
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State | HI
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Zip | 96818-1516
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Country | US
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Telephone | 808-839-3091
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 971617
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City | WAIPAHU
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State | HI
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Zip | 96797-8207
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Country | US
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Telephone | 808-839-3091
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CONSTANTE ALBANO DOMINGO
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Credential |
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Telephone | 808-839-3091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | W3059479201
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License Number State | HI
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