Healthcare Provider Details

I. General information

NPI: 1295837946
Provider Name (Legal Business Name): MINA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N. SCHOOL STREET
HONOLULU HI
96817-1844
US

IV. Provider business mailing address

3375 KOAPAKA STREET, SUITE F245
HONOLULU HI
96819-1816
US

V. Phone/Fax

Practice location:
  • Phone: 808-853-2222
  • Fax: 808-853-2277
Mailing address:
  • Phone: 808-738-4540
  • Fax: 808-690-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberPHY-645
License Number StateHI

VIII. Authorized Official

Name: MR. ADEL ETINAS
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 808-738-4540