Healthcare Provider Details

I. General information

NPI: 1013162486
Provider Name (Legal Business Name): VITAE TRILLES MAGANA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 04/24/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1051 FRANKLIN D ROOSEVELT AVENUE
KAPOLEI HI
96707
US

IV. Provider business mailing address

91-1051 FRANKLIN D . ROOSEVELT AVENUE
KAPOLEI HI
96707
US

V. Phone/Fax

Practice location:
  • Phone: 808-458-5065
  • Fax:
Mailing address:
  • Phone: 808-458-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN60932
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: