| Latitude 19 Medical Inc. | |
|
75-5591 Palani Rd Kailua Kona HI 96740-3631 | |
| (808) 640-3460 | |
| Not Available |
| Full Name | Latitude 19 Medical Inc. |
|---|---|
| Speciality | Clinic/center |
| Location | 75-5591 Palani Rd, Kailua Kona, Hawaii |
| Authorized Official Name and Position | Russell Alan Parker (PRESIDENT) |
| Authorized Official Contact | 7192370590 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Latitude 19 Medical Inc. 75-5737 Kuakini Hwy Ste 202 Kailua Kona HI 96740-1725 Ph: (808) 640-3460 | Latitude 19 Medical Inc. 75-5591 Palani Rd Kailua Kona HI 96740-3631 Ph: (808) 640-3460 |
| NPI Number | 1669841458 |
|---|---|
| Provider Enumeration Date | 09/22/2015 |
| Last Update Date | 09/22/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669841458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | DOS-685 (Hawaii) | Primary |
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