Healthcare Provider Details

I. General information

NPI: 1407859770
Provider Name (Legal Business Name): CARLANN DEFONTES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 HOME OLU PLACE VA CLINIC , PAUL STEVENS OUTPATIENT CLINIC, MOLOKAI GENERAL HOSPITA
KAUNAKAKAI HI
96748
US

IV. Provider business mailing address

PO BOX 408 VA CLINIC @ PAUL STEVENS OUTPATIENT CLINIC
KAUNAKAKAI HI
96748-0408
US

V. Phone/Fax

Practice location:
  • Phone: 808-553-3121
  • Fax:
Mailing address:
  • Phone: 360-929-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDOS 1633
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: