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Mr. Rick J. Long
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NPI Number Detailed Information
Provider Information:
| Name: | Mr. Rick J. Long |
| Gender: | M |
| Provider License Number If Given: | 3550 |
NPI Information:
| NPI: | 1245233477 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 5/23/2005 |
| Last Update Date: | 2/24/2010 |
Provider Business Mailing Address:
| Address: | 121 MAHALANI ST Wailuku, HI 96793 |
| Phone Number: | 8089842150 |
| Fax Number: | 8089842155 |
Provider Business Practice Location Address:
| Address: | 121 MAHALANI ST Wailuku, HI 96793 |
| Phone Number: | 8089842150 |
| Fax Number: |
Provider Taxonomy:
| Primary: | 1041C0700X |
| Secondary (if any): | |
| State: | HI |
