Individual
TREYSEN TAKEO ISHIMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1642 MONA LOOP, HILO, HI 96720-3250
(808) 854-5357
Mailing address
1642 MONA LOOP, HILO, HI 96720-3250
(808) 854-5357
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
CA
Other
Enumeration date
08/17/2023
Last updated
08/18/2023
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