Healthcare Provider Details

I. General information

NPI: 1992209977
Provider Name (Legal Business Name): AZRIEL DROR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-1032 HAWAII BELT RD SUITE 204
KAMUELA HI
96743
US

IV. Provider business mailing address

64-635 PUU NOHO ST
KAMUELA HI
96743-8109
US

V. Phone/Fax

Practice location:
  • Phone: 808-887-6543
  • Fax:
Mailing address:
  • Phone: 623-217-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-21812
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: