Provider Demographics
NPI:1114162518
Name:LGD ENTERPRISE
Entity Type:Organization
Organization Name:LGD ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CONSTANTE
Authorized Official - Middle Name:ALBANO
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-839-3091
Mailing Address - Street 1:PO BOX 971617
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-8207
Mailing Address - Country:US
Mailing Address - Phone:808-839-3091
Mailing Address - Fax:
Practice Address - Street 1:1419 ALA LELEU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-1516
Practice Address - Country:US
Practice Address - Phone:808-839-3091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW3059479201332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies