Provider Demographics
NPI:1225573124
Name:REDONA, LYNDON (I)
Entity Type:Individual
Prefix:
First Name:LYNDON
Middle Name:
Last Name:REDONA
Suffix:
Gender:M
Credentials:I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1065 LUMIAINA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3912
Mailing Address - Country:US
Mailing Address - Phone:808-368-2510
Mailing Address - Fax:
Practice Address - Street 1:94-1065 LUMIAINA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3912
Practice Address - Country:US
Practice Address - Phone:808-368-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-160075313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility