Provider Demographics
NPI:1881361533
Name:GATDULA, NICASIO PAGUIO (VICE PRESIDENT)
Entity type:Individual
Prefix:MR
First Name:NICASIO
Middle Name:PAGUIO
Last Name:GATDULA
Suffix:
Gender:M
Credentials:VICE PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10119
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-5119
Mailing Address - Country:US
Mailing Address - Phone:808-215-7820
Mailing Address - Fax:808-215-7819
Practice Address - Street 1:64 KEAWE ST STE 306
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2486
Practice Address - Country:US
Practice Address - Phone:808-215-7820
Practice Address - Fax:808-215-7819
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide