Healthcare Provider Details

I. General information

NPI: 1013050525
Provider Name (Legal Business Name): HALE LE'A MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 OKA ST #101
KILAUEA HI
96754
US

IV. Provider business mailing address

2460 OKA ST #101
KILAUEA HI
96754
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-67
License Number StateHI

VIII. Authorized Official

Name: DR. STEVEN MATTHEW ROGOFF
Title or Position: PARTNER
Credential: MD
Phone: 808-828-2885