1518948975 NPI number — MR. SANTO JOHN DIMARTINO P.A.-C

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	DIMARTINO
Provider First Name	:	SANTO
Provider Middle Name	:	JOHN
Provider Name Prefix Text	:	MR.
Provider Name Suffix Text	:
Provider Credential Text	:	P.A.-C
Provider Gender Code	:	M

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NPI Number	:	1518948975
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	01/09/2008
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Provider First Line Business Mailing Address	:	91-1088 LAAULU ST
Provider Second Line Business Mailing Address	:	A
Provider Business Mailing Address City Name	:	EWA BEACH
Provider Business Mailing Address State Name	:	HI
Provider Business Mailing Address Postal Code	:	967064300
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	8086835464
Provider Business Mailing Address Fax Number	:	8086835464

Provider First Line Business Practice Location Address	:	480 CENTRAL AVE
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	PEARL HARBOR
Provider Business Practice Location Address State Name	:	HI
Provider Business Practice Location Address Postal Code	:	968604908
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	8084731880
Provider Business Practice Location Address Fax Number	:	8084734411
Provider Enumeration Date	:	11/10/2005

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• Taxonomy code: 363AM0700X , with the licence number:  AMD-41 , registered in the state of HI .