Healthcare Provider Details

I. General information

NPI: 1225850167
Provider Name (Legal Business Name): MEGAN MORISADA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 710
HONOLULU HI
96813-2434
US

IV. Provider business mailing address

2106 KOMO MAI DR
PEARL CITY HI
96782-1331
US

V. Phone/Fax

Practice location:
  • Phone: 808-818-3223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN MORISADA
Title or Position: OWNER
Credential:
Phone: 808-223-7134