Eredulin Vigilla Julian
Individual provider Active NPI Nurse's Aide · Pahoa, HI
NPI 1487130217 · NPPES record last updated Jul 19, 2018
Key facts
- NPI
- 1487130217
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse's Aide 376K00000X
- License
- H1080813287 (HI)
- Practice address
- 15-3226 Hoopili St
Pahoa, HI 96778-6708 - Phone
- (808) 965-9182
- Fax
- (808) 498-0803
- NPI assigned
- Jul 15, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H1080813287 | HI | MD | Nurse's Aide |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | H1080813287 | HI | Yes |
Addresses
Primary practice location
15-3226 Hoopili St
Pahoa, HI 96778-6708
Mailing address
PO Box 966
Pahoa, HI 96778-0966
Phone (808) 936-9394
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12104 | Medicaid | HI |
Other providers in Pahoa, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.