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General NPI Number Information
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NPI Number | 1487130217
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Entity Type | Individual
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Provider Name | EREDULIN VIGILLA JULIAN
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Gender | Female
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Dates
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Enumeration Date | 07/15/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 15-3226 HOOPILI ST
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City | PAHOA
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State | HI
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Zip | 96778-6708
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Country | US
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Telephone | 808-965-9182
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Fax | 808-498-0803
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Provider Business Mailing Address
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Address Line | PO BOX 966
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City | PAHOA
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State | HI
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Zip | 96778-0966
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Country | US
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Telephone | 808-936-9394
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Fax | 808-498-0803
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | H1080813287
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License Number State | HI
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