Provider Demographics
NPI:1144600792
Name:ROUS, REDENTOR CAGUMOC
Entity Type:Individual
Prefix:
First Name:REDENTOR
Middle Name:CAGUMOC
Last Name:ROUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-829 KIMOPELEKANE RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2521
Mailing Address - Country:US
Mailing Address - Phone:808-384-2588
Mailing Address - Fax:808-841-9489
Practice Address - Street 1:91-829 KIMOPELEKANE RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2521
Practice Address - Country:US
Practice Address - Phone:808-384-2588
Practice Address - Fax:808-841-9489
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist