Healthcare Provider Details

I. General information

NPI: 1558770651
Provider Name (Legal Business Name): ULTRACARE DIAGNOSTIC IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 ONEAWA ST STE 102
KAILUA HI
96734-2524
US

IV. Provider business mailing address

122 ONEAWA ST STE 102
KAILUA HI
96734-2524
US

V. Phone/Fax

Practice location:
  • Phone: 808-354-3510
  • Fax:
Mailing address:
  • Phone: 808-354-3510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH HAZELBAKER
Title or Position: OWNER
Credential: RDMS
Phone: 808-354-3510