Healthcare Provider Details

I. General information

NPI: 1518063197
Provider Name (Legal Business Name): PERLITA BOLOSAN LAMPITOC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-235 HANAWAI CIR
WAIPAHU HI
96797-3029
US

IV. Provider business mailing address

94-235 HANAWAI CIR
WAIPAHU HI
96797-3029
US

V. Phone/Fax

Practice location:
  • Phone: 808-671-8539
  • Fax: 808-671-1681
Mailing address:
  • Phone: 808-671-8539
  • Fax: 808-671-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number5020
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: