Healthcare Provider Details

I. General information

NPI: 1871167205
Provider Name (Legal Business Name): HAWAII INFECTIOUS DISEASE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALA MOANA BLVD STE 5-300
HONOLULU HI
96813-4908
US

IV. Provider business mailing address

PO BOX 37056
HONOLULU HI
96837-0056
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-7111
  • Fax: 808-528-5507
Mailing address:
  • Phone: 808-228-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TANYA FLORIN
Title or Position: BILLING MANAGER
Credential:
Phone: 808-228-5436