Healthcare Provider Details

I. General information

NPI: 1972230530
Provider Name (Legal Business Name): MALAMA MOLOKAI HEALTH, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107B ALA MALAMA ST
KAUNAKAKAI HI
96748
US

IV. Provider business mailing address

PO BOX 398
KAUNAKAKAI HI
96748-0398
US

V. Phone/Fax

Practice location:
  • Phone: 808-553-4368
  • Fax:
Mailing address:
  • Phone: 808-553-4638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GENEVIEVE F CORREA
Title or Position: OWNER
Credential: DPT
Phone: 808-650-2339