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General NPI Number Information
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NPI Number | 1013075852
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Entity Type | Individual
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Provider Name | MARIVIC CRISTOBAL RAYMUNDO M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 915 N KING ST
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City | HONOLULU
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State | HI
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Zip | 96817-4544
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Country | US
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Telephone | 808-848-1438
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Fax |
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Provider Business Mailing Address
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Address Line | 824 CRESCENT TRCE
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3593
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Country | US
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Telephone | 757-580-6938
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101230921
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD-20471
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License Number State | HI
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