Provider Demographics
NPI:1639717499
Name:LANSANGAN, SOLIVEN PARAS JR
Entity Type:Individual
Prefix:
First Name:SOLIVEN
Middle Name:PARAS
Last Name:LANSANGAN
Suffix:JR
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 1:1001 KAMOKILA BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2095
Mailing Address - Country:US
Mailing Address - Phone:808-674-0500
Mailing Address - Fax:
Practice Address - Street 1:1001 KAMOKILA BLVD STE 114
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2095
Practice Address - Country:US
Practice Address - Phone:808-674-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist