Provider Demographics
NPI:1003016486
Name:GABRIELA ORTIZ-OMPHROY MD LLC
Entity Type:Organization
Organization Name:GABRIELA ORTIZ-OMPHROY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:ORTIZ-OMPHROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-487-7700
Mailing Address - Street 1:98-1079 MOANALUA RD STE 680
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4725
Mailing Address - Country:US
Mailing Address - Phone:808-487-7700
Mailing Address - Fax:808-488-4151
Practice Address - Street 1:98-1079 MOANALUA RD STE 680
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4725
Practice Address - Country:US
Practice Address - Phone:808-487-7700
Practice Address - Fax:808-488-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53927313Medicaid
HIH55672Medicare PIN
HI53927313Medicaid