Provider Demographics
NPI:1538730726
Name:BADUA, JHOMEL DESCALZO (TAXI SERVICE)
Entity type:Individual
Prefix:
First Name:JHOMEL
Middle Name:DESCALZO
Last Name:BADUA
Suffix:
Gender:M
Credentials:TAXI SERVICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17-606 S IPUAIWAHA PL
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-8209
Mailing Address - Country:US
Mailing Address - Phone:808-430-7301
Mailing Address - Fax:
Practice Address - Street 1:16-1584 34TH AVE
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749
Practice Address - Country:US
Practice Address - Phone:808-430-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
H01332106172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver