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General NPI Number Information
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NPI Number | 1366514291
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Entity Type | Organization
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Legal Business Name | WAIKOLOA MEDICAL ARTS, INC.
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 64-1035 MAMALAHOA HWY SUITE K
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City | KAMUELA
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State | HI
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Zip | 96743-8440
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Country | US
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Telephone | 808-883-9785
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Fax | 808-883-9783
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Provider Business Mailing Address
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Address Line | 64-1035 MAMALAHOA HWY SUITE K
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City | KAMUELA
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State | HI
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Zip | 96743-8440
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Country | US
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Telephone | 808-883-9785
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Fax | 808-883-9783
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BAYARDO JOSE AVILES
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Credential |
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Telephone | 808-960-5792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MD7441
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License Number State | HI
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