Individual
GWENDOLYN BUENAVISTA COLOMA CABACCANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
98-820 MOANALUA RD SPC 5-726, AIEA, HI 96701-5200
(808) 342-1611
(808) 443-0943
Mailing address
98-820 MOANALUA RD SPC 5-726, AIEA, HI 96701-5200
(808) 342-1611
(808) 443-0943
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
1606814678
NV
Other
Enumeration date
07/20/2022
Last updated
07/20/2022
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