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General NPI Number Information
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NPI Number | 1255646543
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Entity Type | Organization
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Legal Business Name | PRINCESS JOY DOMNGO
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 73-1340 KAIMINANI DR
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City | KAILUA KONA
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State | HI
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Zip | 96740-8521
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Country | US
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Telephone | 808-325-3237
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Fax | 808-325-3237
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Provider Business Mailing Address
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Address Line | 73-1340 KAIMINANI DR
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City | KAILUA KONA
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State | HI
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Zip | 96740-8521
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Country | US
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Telephone | 808-325-3237
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Fax | 808-325-3237
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Authorized Official
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Title or Position | CNA
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Name | MRS. PRINCESS JOY F DOMINGO
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Credential |
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Telephone | 808-325-3237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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