Provider Demographics
NPI:1790054302
Name:GANI, VILLAMOR E SR
Entity Type:Individual
Prefix:MR
First Name:VILLAMOR
Middle Name:E
Last Name:GANI
Suffix:SR
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 1:2290 AWAPUHI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5387
Mailing Address - Country:US
Mailing Address - Phone:808-959-0404
Mailing Address - Fax:808-959-4477
Practice Address - Street 1:2290 AWAPUHI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5387
Practice Address - Country:US
Practice Address - Phone:808-959-0404
Practice Address - Fax:808-959-4477
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH1020408677376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide