Healthcare Provider Details

I. General information

NPI: 1689873184
Provider Name (Legal Business Name): KAMBRIA BECK HOLDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 OKA ST STE 101A
KILAUEA HI
96754-5308
US

IV. Provider business mailing address

PO BOX 1158
KILAUEA HI
96754-1158
US

V. Phone/Fax

Practice location:
  • Phone: 808-828-2885
  • Fax: 808-828-0119
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA101959
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-21470
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: