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General NPI Number Information
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NPI Number | 1972230530
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Entity Type | Organization
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Legal Business Name | MALAMA MOLOKAI HEALTH, LTD
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 107B ALA MALAMA ST
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City | KAUNAKAKAI
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State | HI
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Zip | 96748
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Country | US
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Telephone | 808-553-4368
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 398
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City | KAUNAKAKAI
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State | HI
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Zip | 96748-0398
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Country | US
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Telephone | 808-553-4638
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GENEVIEVE F CORREA
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Credential | DPT
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Telephone | 808-650-2339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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