Organization
FACIAL808
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLARENE KUULEIALOHA VOGELGESANG (OWNER)
(808) 457-0330
Entity
Organization
Contact information
Practice address
73-4520 HAWAII BELT ROAD, KAILUA-KONA, HI 96740
(808) 457-0330
Mailing address
73-4520 HAWAII BELT ROAD, KAILUA-KONA, HI 96740
(808) 457-0330
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
MAT 3913
HI
Other
Enumeration date
05/20/2014
Last updated
05/20/2014
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