Organization
LATITUDE 19 MEDICAL INC.
Active
Organization
LATITUDE 19 MEDICAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL ALAN PARKER D.O. (PRESIDENT)
(719) 237-0590
Entity
Organization
Contact information
Practice address
75-5591 PALANI RD, KAILUA KONA, HI 96740-3631
(808) 640-3460
Mailing address
75-5737 KUAKINI HWY STE 202, KAILUA KONA, HI 96740-1725
(808) 640-3460
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
DOS-685
HI
Other
Enumeration date
09/22/2015
Last updated
09/22/2015
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