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General NPI Number Information
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NPI Number | 1912234196
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Entity Type | Organization
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Legal Business Name | GLORIA M MADAMBA MD INC
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 1712 LILIHA STREET SUITE 203 LILIHA MEDICAL BLG.
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City | HONOLULU
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State | HI
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Zip | 96817
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Country | US
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Telephone | 808-523-7955
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Fax | 808-536-9498
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Provider Business Mailing Address
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Address Line | 1712 LILIHA STREET SUITE 203 LILIHA MEDICAL BLG.
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City | HONOLULU
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State | HI
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Zip | 96817
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Country | US
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Telephone | 808-523-7955
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Fax | 808-536-9498
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Authorized Official
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Title or Position | M.D.
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Name | DR. GLORIA M MADAMBA
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Credential |
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Telephone | 808-523-7955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2605
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License Number State | HI
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