1154760643 NPI number — DAVID J MOLS RPT INC

Table of content: LINO LOPEZ JR. NP-C (NPI 1104405653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154760643 NPI number — DAVID J MOLS RPT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID J MOLS RPT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1154760643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99-128 AIEA HEIGHTS DR STE 701
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIEA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96701-3940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-488-5665
Provider Business Mailing Address Fax Number:
808-486-6090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99-128 AIEA HEIGHTS DR STE 701
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-3940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-488-5665
Provider Business Practice Location Address Fax Number:
808-486-6090
Provider Enumeration Date:
06/18/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOLS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
808-488-5665

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT-416 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: H0000CBBCB . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".