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Individual

EREDULIN VIGILLA JULIAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
15-3226 HOOPILI ST, PAHOA, HI 96778-6708
(808) 965-9182
(808) 498-0803
Mailing address
PO BOX 966, PAHOA, HI 96778-0966
(808) 936-9394
(808) 498-0803

Taxonomy

Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
H1080813287
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
12104
HI
Enumeration date
07/15/2018
Last updated
07/19/2018
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