Healthcare Provider Details

I. General information

NPI: 1780861229
Provider Name (Legal Business Name): GATEWAY URGENT CARE CLINIC, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-378 PUPUPANI STREET 102
WAIPAHU HI
96797-2648
US

IV. Provider business mailing address

94-378 PUPUPANI STREET 102
WAIPAHU HI
96797-2648
US

V. Phone/Fax

Practice location:
  • Phone: 808-677-1433
  • Fax: 808-677-1676
Mailing address:
  • Phone: 808-677-1433
  • Fax: 808-677-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number8981
License Number StateHI

VIII. Authorized Official

Name: DR. SORBELLA M GUILLERMO
Title or Position: OWNER MEMBER
Credential: M.D.
Phone: 808-677-1433