Healthcare Provider Details

I. General information

NPI: 1154492080
Provider Name (Legal Business Name): VANESSA HISA FIDELE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 211 PALI MOMI ST SUITE 618
AIEA HI
96701-4337
US

IV. Provider business mailing address

98 211 PALI MOMI ST SUITE 618
AIEA HI
96701-4337
US

V. Phone/Fax

Practice location:
  • Phone: 808-486-7799
  • Fax:
Mailing address:
  • Phone: 808-486-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD6554
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: