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General NPI Number Information
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NPI Number | 1477305506
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Entity Type | Organization
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Legal Business Name | WAILUKU INTERNAL MEDICINE CLINIC LLC
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Dates
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Enumeration Date | 04/02/2024
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 1063 LOWER MAIN ST STE C106
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City | WAILUKU
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State | HI
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Zip | 96793-6035
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Country | US
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Telephone | 808-242-6478
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Fax |
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Provider Business Mailing Address
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Address Line | 1063 LOWER MAIN ST STE C106
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City | WAILUKU
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State | HI
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Zip | 96793-6035
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Country | US
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Telephone | 808-242-6478
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MARIA CHARITO GONZALES TERMULO
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Credential | MD
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Telephone | 808-269-3918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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