Healthcare Provider Details

I. General information

NPI: 1609095595
Provider Name (Legal Business Name): MARINA A. BADUA, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 LILIHA ST 202
HONOLULU HI
96817-5410
US

IV. Provider business mailing address

1712 LILIHA ST 202
HONOLULU HI
96817-5410
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-1754
  • Fax: 808-536-0315
Mailing address:
  • Phone: 808-536-1754
  • Fax: 808-536-0315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberMD3187
License Number StateHI

VIII. Authorized Official

Name: MARINA AGUIRAN BADUA
Title or Position: CHAIRMAN OF THE BOARD
Credential: M.D.
Phone: 808-536-1754