Healthcare Provider Details

I. General information

NPI: 1093912610
Provider Name (Legal Business Name): BERNARD ANTHONY RIOLA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 01/20/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

4643 B WAIMEA CANYON DRIVE
WAIMEA HI
96796-0337
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-6000
  • Fax:
Mailing address:
  • Phone: 808-338-8311
  • Fax: 808-338-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5262
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: