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Individual

ATHENA ORDEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
94-1100 KAAHOLO ST, WAIPAHU, HI 96797-1254
(808) 692-6161
Mailing address
94-1100 KAAHOLO ST, WAIPAHU, HI 96797-1254
(808) 692-6161

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
W88288251-01
HI

Other

Enumeration date
12/02/2015
Last updated
12/02/2015
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