Healthcare Provider Details

I. General information

NPI: 1922766203
Provider Name (Legal Business Name): SUSAN VICENTI MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 02/02/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 AARONA PL STE 201
KAILUA HI
96734-2545
US

IV. Provider business mailing address

1585 KAPIOLANI BLVD STE 1800
HONOLULU HI
96814-4500
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-3206
  • Fax:
Mailing address:
  • Phone: 808-941-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN VICENTI
Title or Position: MD/OWNER
Credential: MD
Phone: 808-261-3000