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General NPI Number Information
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NPI Number | 1902300056
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Entity Type | Organization
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Legal Business Name | HAWAII CARE CONNECT MEDICAL GROUP LLC
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 94-356 WAIPAHU DEPOT ST STE 204
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City | WAIPAHU
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State | HI
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Zip | 96797-3057
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Country | US
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Telephone | 808-439-4729
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Fax |
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Provider Business Mailing Address
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Address Line | 94-356 WAIPAHU DEPOT ST STE 204
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City | WAIPAHU
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State | HI
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Zip | 96797-3057
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Country | US
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Telephone | 808-439-4729
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LORETTA UBANTE
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Credential | RN
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Telephone | 808-439-4729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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