Healthcare Provider Details

I. General information

NPI: 1316628738
Provider Name (Legal Business Name): HEAL DIABETES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S BERETANIA ST STE 500
HONOLULU HI
96814-1520
US

IV. Provider business mailing address

1360 S BERETANIA ST STE 500
HONOLULU HI
96814-1520
US

V. Phone/Fax

Practice location:
  • Phone: 808-210-4444
  • Fax: 808-210-5505
Mailing address:
  • Phone: 808-210-4444
  • Fax: 808-210-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MARC PIERRE DESGRAVES IV
Title or Position: PRESIDENT
Credential:
Phone: 972-743-3935