Organization
MMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAGDALENA A. BALTAZAR (OWNER)
(808) 677-4969
Entity
Organization
Contact information
Practice address
94-904 KUAKAHI ST, WAIPAHU, HI 96797-2808
(808) 677-4969
(808) 677-4969
Mailing address
94-904 KUAKAHI ST, WAIPAHU, HI 96797-2808
(808) 677-4969
(808) 677-4969
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
W0423010802
HI
Other
Enumeration date
11/20/2006
Last updated
08/22/2020
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