Provider Demographics
NPI:1750531083
Name:RUDOMETKIN, DANNY MICHAEL (MAEC)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:MICHAEL
Last Name:RUDOMETKIN
Suffix:
Gender:M
Credentials:MAEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-169 WAILAWA ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3205
Mailing Address - Country:US
Mailing Address - Phone:808-306-6665
Mailing Address - Fax:
Practice Address - Street 1:95-169 WAILAWA ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3205
Practice Address - Country:US
Practice Address - Phone:808-306-6665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI110188101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool