=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619382629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACPAYUMO MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2014
-----------------------------------------------------
Last Update Date | 08/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 PUNCHBOWL ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-983-9648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 22399
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96823-2399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-983-9648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANGELA COLLEEN ALCID PAYUMO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 808-983-9648
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 17502
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | MD17502
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------