1154556280 NPI number — MR. RODNEY VALDECANAS ACASIO IDMT

Table of content: MR. RODNEY VALDECANAS ACASIO IDMT (NPI 1154556280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154556280 NPI number — MR. RODNEY VALDECANAS ACASIO IDMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACASIO
Provider First Name:
RODNEY
Provider Middle Name:
VALDECANAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IDMT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154556280
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 KOPIKO ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96818-5429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-474-4959
Provider Business Mailing Address Fax Number:
808-474-4880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 WORCHESTER AVE BLDG 45
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKAM AFB
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96853-5530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-474-4959
Provider Business Practice Location Address Fax Number:
808-474-4880
Provider Enumeration Date:
05/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1710I1003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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