Healthcare Provider Details

I. General information

NPI: 1306598065
Provider Name (Legal Business Name): PERLITA BOLOSAN LAMPITOC MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-235 HANAWAI CIR STE 8
WAIPAHU HI
96797-3029
US

IV. Provider business mailing address

94-235 HANAWAI CIR STE 8
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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PERLITA B MAMPITOC
Title or Position: PRESIDENT
Credential: MD
Phone: 808-671-8539