MEDICARE: GLENDA MALANA 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	207R00000X	Internal Medicine Physician	MD9260	HI

General Provider Information

NPI Number	:	1639103070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA MALANA MD

Provider Business Mailing Address
First Line	:	91-1025 HOOMAALILI ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-5954
Country	:	US
Telephone Number	:	808-683-1026
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-2139 FORT WEAVER RD STE 302
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3609
Country	:	US
Telephone Number	:	775-219-6855
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	09/14/2007

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