Basic Information
| Provider Information | |||||||||
| NPI: | 1215209424 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NDC MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25668 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968250668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085360300 | ||||||||
| FaxNumber: | 8085360320 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 ALA MOANA BLVD | ||||||||
| Address2: | SUITE 1-B | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968134920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085282511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2012 | ||||||||
| LastUpdateDate: | 02/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | DUCA-CRUZ | ||||||||
| AuthorizedOfficialFirstName: | NANNETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8082210496 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD-14574 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.