Healthcare Provider Details

I. General information

NPI: 1669289898
Provider Name (Legal Business Name): MARIA EXCELLSIS DELA CRUZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST STE 102
HONOLULU HI
96814-1871
US

IV. Provider business mailing address

94-1010 AWANANI ST
WAIPAHU HI
96797-3248
US

V. Phone/Fax

Practice location:
  • Phone: 808-356-5699
  • Fax:
Mailing address:
  • Phone: 808-383-0949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-1420
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: