Healthcare Provider Details

I. General information

NPI: 1861680431
Provider Name (Legal Business Name): LEOVIGILDO RAMIREZ JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 LILIHA ST STE 304
HONOLULU HI
96817-3114
US

IV. Provider business mailing address

1712 LILIHA ST STE 304
HONOLULU HI
96817-3114
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-1313
  • Fax:
Mailing address:
  • Phone: 808-522-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125050193
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14748
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: