Healthcare Provider Details

I. General information

NPI: 1508513136
Provider Name (Legal Business Name): FLORA MEDINA-MANUEL, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2153 N KING ST STE 325
HONOLULU HI
96819-4560
US

IV. Provider business mailing address

2153 N KING ST STE 325
HONOLULU HI
96819-4560
US

V. Phone/Fax

Practice location:
  • Phone: 808-845-7173
  • Fax: 808-845-7173
Mailing address:
  • Phone: 808-845-7173
  • Fax: 808-841-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FLORA MEDINA-MANUEL
Title or Position: PRESIDENT
Credential: MD
Phone: 808-845-7173