Healthcare Provider Details

I. General information

NPI: 1619382629
Provider Name (Legal Business Name): ACPAYUMO MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

PO BOX 22399
HONOLULU HI
96823-2399
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-9648
  • Fax:
Mailing address:
  • Phone: 808-983-9648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD17502
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number17502
License Number StateHI

VIII. Authorized Official

Name: ANGELA COLLEEN ALCID PAYUMO
Title or Position: OWNER
Credential: M.D.
Phone: 808-983-9648