Provider Demographics
NPI:1649639915
Name:CARDIOPULMONARY DIAGNOSTIC SERVICES, INC
Entity type:Organization
Organization Name:CARDIOPULMONARY DIAGNOSTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RIDA
Authorized Official - Middle Name:TR
Authorized Official - Last Name:CABANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-841-2778
Mailing Address - Street 1:2070 N. KING STREET A2
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3458
Mailing Address - Country:US
Mailing Address - Phone:808-678-1422
Mailing Address - Fax:808-678-2278
Practice Address - Street 1:2070 N KING ST # A2
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3481
Practice Address - Country:US
Practice Address - Phone:808-678-1422
Practice Address - Fax:808-678-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH54132247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI136655068OtherNPI