Provider Demographics
NPI:1093987877
Name:AMDUR, C. LATIFA (LIC AC)
Entity Type:Individual
Prefix:
First Name:C. LATIFA
Middle Name:
Last Name:AMDUR
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1270
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-1270
Mailing Address - Country:US
Mailing Address - Phone:808-828-1155
Mailing Address - Fax:
Practice Address - Street 1:148A ROYAL DRIVE
Practice Address - Street 2:
Practice Address - City:KAPA'A
Practice Address - State:HI
Practice Address - Zip Code:96746
Practice Address - Country:US
Practice Address - Phone:808-828-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist