Basic Information
| Provider Information | |||||||||
| NPI: | 1407134828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDRENS ENDOCRINOLOGY CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25490 | ||||||||
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| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968250490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085360300 | ||||||||
| FaxNumber: | 8085360320 | ||||||||
| Practice Location | |||||||||
| Address1: | 75-5591 PALANI RD | ||||||||
| Address2: | STE 2002 | ||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967403631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083259484 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2011 | ||||||||
| LastUpdateDate: | 08/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | RAMAYYA | ||||||||
| AuthorizedOfficialFirstName: | MEERA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8083259484 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | MD-15930 | HI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.