Healthcare Provider Details

I. General information

NPI: 1548433501
Provider Name (Legal Business Name): MARY-ROSE BELEN VALINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 11/18/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MDG 755 SCOTT CIRCLE
HICKAM AFB HI
96853
US

IV. Provider business mailing address

755 SCOTT CIR JBPH-HICKAM
HICKAM AFB HI
96853
US

V. Phone/Fax

Practice location:
  • Phone: 808-448-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101250035
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: