Healthcare Provider Details

I. General information

NPI: 1265672471
Provider Name (Legal Business Name): EMMANUEL RAMIREZ ENRIQUEZ KLING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE ROAD TRIPLER ARMY MEDICAL CENTER NEONATAL INTENSIVE CARE UNIT
HONOLULU HI
96859-5000
US

IV. Provider business mailing address

1 JARRETT WHITE ROAD TRIPLER ARMY MEDICAL CENTER NEONATAL INTENSIVE CARE UNIT
HONOLULU HI
96859-5000
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-5460
  • Fax:
Mailing address:
  • Phone: 808-433-5460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number15832
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberQ4164
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: