Organization
PACIFIC RIM CARDIOVASCULAR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT RANDOLPH WATERFORD MD (PRESIDENT)
(808) 268-5789
Entity
Organization
Contact information
Practice address
385 HUKILIKE ST., SUITE 210, KAHULUI, HI 96732
(808) 871-8346
Mailing address
PO BOX 923, WAILUKU, HI 96793-0923
(808) 268-5789
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
15055
HI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
15055
HI
Other
Enumeration date
05/11/2010
Last updated
02/20/2013
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