Provider Demographics
NPI:1386494037
Name:LUZANO, RUSSEL CABANTING
Entity type:Individual
Prefix:
First Name:RUSSEL
Middle Name:CABANTING
Last Name:LUZANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 970174
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-0174
Mailing Address - Country:US
Mailing Address - Phone:808-542-8317
Mailing Address - Fax:
Practice Address - Street 1:94-1077 LUMIAINA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3912
Practice Address - Country:US
Practice Address - Phone:808-542-8317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI992052284OtherIRS