Provider Demographics
NPI:1558493700
Name:SAMUEL, MARTHA MACHEL
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MACHEL
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419A ATKINSON DR
Mailing Address - Street 2:APT 301
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4731
Mailing Address - Country:US
Mailing Address - Phone:707-490-8910
Mailing Address - Fax:
Practice Address - Street 1:400 SAND ISLAND ACCESS RD
Practice Address - Street 2:USCGC JARVIS (WHEC-725)
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4731
Practice Address - Country:US
Practice Address - Phone:808-842-2287
Practice Address - Fax:808-842-2897
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other