Basic Information
| Provider Information | |||||||||
| NPI: | 1053960583 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUILLORY | ||||||||
| FirstName: | DAHLIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 828 LAULA WAY | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968142246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086364518 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 KAMOKILA BLVD STE 206 | ||||||||
| Address2: | |||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967072096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085916060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2019 | ||||||||
| LastUpdateDate: | 09/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-19-91597 | HI | Y | 193200000X MULTI-SPECIALTY GROUP |
No ID Information.