MEDICARE: GLENDA V. MALANA, M.D. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD-9620	HI

General Provider Information

NPI Number	:	1629257498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDA V. MALANA, M.D. LLC

Provider Business Mailing Address
First Line	:	91-2139 FORT WEAVER RD STE 302
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3609
Country	:	US
Telephone Number	:	808-678-0045
Fax Number	:	808-678-0048

Provider Business Practice Location Address
First Line	:	91-2139 FORT WEAVER RD STE 302
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3609
Country	:	US
Telephone Number	:	808-678-0045
Fax Number	:	808-678-0048

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GLENDA MALANA
Credential	:	M.D.
Telephone Number	:	808-678-0045

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	10/30/2007

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