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Individual

MIKA GORGONIO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
91-1026 KAIMALIE ST APT Q1, EWA BEACH, HI 96706-5012
(808) 366-0215
Mailing address
91-1026 KAIMALIE ST APT Q1, EWA BEACH, HI 96706-5012
(808) 366-0215

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MAT 13853
HI

Other

Enumeration date
01/28/2016
Last updated
01/28/2016
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