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General NPI Number Information
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NPI Number | 1255977864
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Entity Type | Organization
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Legal Business Name | HAWAII SHOULDER AND ORTHOPEDIC INSTITUTE LLC
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 670 KEKUANAOA ST
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City | HILO
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State | HI
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Zip | 96720-4405
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Country | US
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Telephone | 808-935-3378
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Fax | 808-961-0498
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Provider Business Mailing Address
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Address Line | PO BOX 10742
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City | HILO
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State | HI
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Zip | 96721-5742
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Country | US
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Telephone | 808-935-3375
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Fax | 808-961-0498
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Authorized Official
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Title or Position | BILLING AND CREDENTIALING
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Name | MRS. RAQUEL ANN BOROMEO
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Credential |
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Telephone | 808-987-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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