Individual
RUSSELL MENDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1786 KINOOLE ST, HILO, HI 96720-5245
(714) 316-3868
Mailing address
1786 KINOOLE ST, HILO, HI 96720-5245
(808) 959-5855
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/23/2020
Last updated
03/23/2020
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