Healthcare Provider Details

I. General information

NPI: 1508804584
Provider Name (Legal Business Name): DARREN S GELIGA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-6107 HOOMAMA ST
KAILUA KONA HI
96740-7953
US

IV. Provider business mailing address

75-170 HUALALAI RD STE C110
KAILUA KONA HI
96740-1780
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-9082
  • Fax: 808-329-9082
Mailing address:
  • Phone: 808-329-9211
  • Fax: 808-329-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1052842
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: