Healthcare Provider Details

I. General information

NPI: 1780337832
Provider Name (Legal Business Name): NENITA BALA-ALBANO MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2022
Last Update Date: 01/29/2022
Certification Date: 01/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-216 FARRINGTON HWY STE A103
WAIPAHU HI
96797-1922
US

IV. Provider business mailing address

PO BOX 970749
WAIPAHU HI
96797-0749
US

V. Phone/Fax

Practice location:
  • Phone: 808-680-0558
  • Fax: 808-680-0500
Mailing address:
  • Phone: 808-680-0558
  • Fax: 808-680-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NENITA BALA-ALBANO
Title or Position: EMPLOYEE
Credential: MD
Phone: 808-927-6081