Healthcare Provider Details

I. General information

NPI: 1902196314
Provider Name (Legal Business Name): REIS PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
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 TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRIJIIT REIS
Title or Position: OWNER
Credential: MD
Phone: 808-263-8822