Organization
VENTURE MEDICAL 21 INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSE D REQUE (PRESIDENT)
(808) 531-7878
Entity
Organization
Contact information
Practice address
91-896 MAKULE RD STE 102, EWA BEACH, HI 96706-2543
(808) 689-4414
(808) 689-7115
Mailing address
810 RICHARDS ST STE 990, HONOLULU, HI 96813-4722
(808) 531-7878
(808) 531-7829
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W8141213401
STATE OF HAWAII
HI
Enumeration date
07/26/2012
Last updated
08/15/2014
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