=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942291364
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINCENTE S RAMO MD PC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2055 N KING ST SUITE 108
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96819-3479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-841-7288
-----------------------------------------------------
Fax | 808-841-8841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2055 N KING ST SUITE 108
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96819-3479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-841-7288
-----------------------------------------------------
Fax | 808-841-8841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VINCENTE SEPARA RAMO JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-841-7288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 10117
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------