Basic Information
| Provider Information | |||||||||
| NPI: | 1487253092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARIN | ||||||||
| FirstName: | DIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 S ALU RD | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967931510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3003007444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 427 ALA MAKANI ST | ||||||||
| Address2: | |||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967323507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082446879 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2020 | ||||||||
| LastUpdateDate: | 10/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | HI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP |
No ID Information.