Healthcare Provider Details

I. General information

NPI: 1710935424
Provider Name (Legal Business Name): IDALEE PIA CABALLERO POSA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-549 PLUMERIA ST
HONOKAA HI
96727-6902
US

IV. Provider business mailing address

45-549 PLUMERIA ST
HONOKAA HI
96727-6902
US

V. Phone/Fax

Practice location:
  • Phone: 808-775-7204
  • Fax: 808-775-9404
Mailing address:
  • Phone: 808-775-7204
  • Fax: 808-775-7204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD25436
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-18468
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: