Healthcare Provider Details

I. General information

NPI: 1598850141
Provider Name (Legal Business Name): BRIJIT BERTSCHE REIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIT MEEHAN BERTSCHE MD

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 AULIKE ST SUITE 500
KAILUA HI
96734-2739
US

IV. Provider business mailing address

30 AULIKE ST SUITE 500
KAILUA HI
96734-2739
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-8822
  • Fax: 808-261-6749
Mailing address:
  • Phone: 808-263-8822
  • Fax: 808-261-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG196174
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11900
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: