Provider Information for 1508132572
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ELIJAH DAVENPORT
Sex: Male
NPI: 1508132572
Last Updated: 2024-01-03
Certification Date: 2024-01-03
Certification Date: 2024-01-03
Details
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NPI | 1508132572 | ||||||||
Enumeration Date | 2012-03-23 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | PO BOX 22922 HONOLULU, HI 96823-2922 United States Phone: 808-450-4344 | Fax: | ||||||||
Primary Practice Address | 615 PIIKOI ST SUITE 203 HONOLULU, HI 96814-3116 United States Phone: 808-589-1829 | Fax:808-589-2610 | ||||||||
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