Healthcare Provider Details

I. General information

NPI: 1285393991
Provider Name (Legal Business Name): ENRIQUE VILLARREAL MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 WAIMANU ST STE 614
HONOLULU HI
96813-5267
US

IV. Provider business mailing address

875 WAIMANU ST STE 614
HONOLULU HI
96813-5267
US

V. Phone/Fax

Practice location:
  • Phone: 808-286-1961
  • Fax:
Mailing address:
  • Phone: 808-286-1961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NATALIE RAMOS
Title or Position: CREDENTIALING
Credential:
Phone: 808-431-3210