MEDICARE: MARTA L DERIEG MD

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	208000000X	Pediatrics Physician	MD10708	HI
2	2080A0000X	Pediatric Adolescent Medicine Physician	MD10708	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538124979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTA L DERIEG MD

Provider Business Mailing Address
First Line	:	76-6225 KUAKINI HWY
Second Line	:	STE C101
City	:	KAILUA KONA
State	:	HI
Zip	:	96740-3212
Country	:	US
Telephone Number	:	808-329-7067
Fax Number	:	808-329-2404

Provider Business Practice Location Address
First Line	:	76-6225 KUAKINI HWY
Second Line	:	STE C101
City	:	KAILUA KONA
State	:	HI
Zip	:	96740-3212
Country	:	US
Telephone Number	:	808-329-7067
Fax Number	:	808-329-2404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	12/03/2013

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Directions to “ MARTA L DERIEG MD” Practice Location

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