Provider Demographics
NPI:1285235010
Name:GASMEN, ALEXANDER R (ATC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:R
Last Name:GASMEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1211 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3297
Mailing Address - Country:US
Mailing Address - Phone:808-307-9555
Mailing Address - Fax:808-675-0257
Practice Address - Street 1:94-1211 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3297
Practice Address - Country:US
Practice Address - Phone:808-307-9555
Practice Address - Fax:808-675-0257
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI012570Medicaid