Healthcare Provider Details

I. General information

NPI: 1508799065
Provider Name (Legal Business Name): MAUI PEDIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 S PUUNENE AVE
KAHULUI HI
96732-2121
US

IV. Provider business mailing address

53 S PUUNENE AVE
KAHULUI HI
96732-2121
US

V. Phone/Fax

Practice location:
  • Phone: 732-351-9405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IRENE PAPACONSTADOPOULOS
Title or Position: OWNER
Credential: MD
Phone: 732-351-9405