Healthcare Provider Details

I. General information

NPI: 1962398529
Provider Name (Legal Business Name): MILILANI GASTRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-390 KUAHELANI AVE UNIT 4A-1
MILILANI HI
96789-1192
US

IV. Provider business mailing address

95-390 KUAHELANI AVE UNIT 4A-1
MILILANI HI
96789-1192
US

V. Phone/Fax

Practice location:
  • Phone: 808-722-4028
  • Fax: 888-220-7388
Mailing address:
  • Phone: 808-722-4028
  • Fax: 888-220-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARYSON CABREROS CABUDOY
Title or Position: MANAGER
Credential: RN, BSN
Phone: 808-722-4028