MEDICARE: MALAMA CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1033082920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALAMA CARE LLC

Provider Business Mailing Address
First Line	:	91-1007 WAIILIKAHI ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6407
Country	:	US
Telephone Number	:	917-582-2356
Fax Number	:	808-207-2553

Provider Business Practice Location Address
First Line	:	91-1007 WAIILIKAHI ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6407
Country	:	US
Telephone Number	:	917-582-2356
Fax Number	:	808-207-2553

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT
Name	:	MRS. TERESA R. GONZALEZ
Credential	:	PA
Telephone Number	:	917-582-2356

Provider Enumeration Date	:	09/26/2025
Last Update Date	:	09/26/2025

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Directions to “MALAMA CARE LLC ” Practice Location

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