Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DIO-246 | HI |
NPI | 1144460395 |
---|---|
Provider Name | Mr. Venerando Torres Gatdula |
First Address | Waipahu, HI 96797-3551 |
Second Address | Waipahu, HI 96797-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2009 |
Last Update Date | 01/03/2009 |