Provider Demographics
NPI:1457886608
Name:HAWAII PACIFIC DME INC
Entity Type:Organization
Organization Name:HAWAII PACIFIC DME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:REQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:808-226-8119
Mailing Address - Street 1:98-1247 KAAHUMANU ST STE 106
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5310
Mailing Address - Country:US
Mailing Address - Phone:808-226-8119
Mailing Address - Fax:808-486-1522
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 106
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5310
Practice Address - Country:US
Practice Address - Phone:808-226-8119
Practice Address - Fax:808-486-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIGE-043-921-2032OtherHAWAII TAX ID