Healthcare Provider Details

I. General information

NPI: 1376978288
Provider Name (Legal Business Name): ISLAND PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 PONAHAWAI ST
HILO HI
96720-3027
US

IV. Provider business mailing address

PO BOX 25490
HONOLULU HI
96825-0490
US

V. Phone/Fax

Practice location:
  • Phone: 808-933-2982
  • Fax: 808-933-2983
Mailing address:
  • Phone: 808-536-0314
  • Fax: 808-536-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD-8588
License Number StateHI

VIII. Authorized Official

Name: JOSEPH A D'ANGELO
Title or Position: OWNER
Credential: M.D.
Phone: 808-933-2982