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General NPI Number Information
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NPI Number | 1780832584
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Entity Type | Organization
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Legal Business Name | LUZ PATRICIA MEDINA MD INC
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 99 S MARKET ST STE 103
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City | WAILUKU
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State | HI
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Zip | 96793-2252
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Country | US
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Telephone | 808-249-8862
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Fax |
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Provider Business Mailing Address
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Address Line | 99 S MARKET ST STE 103
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City | WAILUKU
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State | HI
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Zip | 96793-2252
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. LAURA MEDINA
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Credential |
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Telephone | 808-249-8862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD14001
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License Number State | HI
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