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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 |