Healthcare Provider Details

I. General information

NPI: 1750029211
Provider Name (Legal Business Name): MAIKAI HEARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 709
HONOLULU HI
96817-2362
US

IV. Provider business mailing address

990 AULOA RD
KAILUA HI
96734-4603
US

V. Phone/Fax

Practice location:
  • Phone: 808-528-0005
  • Fax:
Mailing address:
  • Phone: 808-426-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GISELLE ADRIANA BAQUERO
Title or Position: PRESIDENT
Credential: MD
Phone: 808-426-6030