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General NPI Number Information
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NPI Number | 1225130974
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Entity Type | Organization
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Legal Business Name | MINA CORPORATION
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 1441 KAPIOLANI BLVD #510
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City | HONOLULU
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State | HI
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Zip | 96814-4403
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Country | US
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Telephone | 808-945-9366
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Fax | 808-943-9620
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Provider Business Mailing Address
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Address Line | 3375 KOAPAKA STREET, SUITE F245
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City | HONOLULU
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State | HI
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Zip | 96819-1816
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Country | US
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Telephone | 808-738-4540
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Fax | 808-690-9174
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ADEL ETINAS
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Credential | R.PH.
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Telephone | 808-738-4540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | PHY-596
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License Number State | HI
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