Provider Demographics
NPI:1003913146
Name:GUILLERMO, SORBELLA MAULIT (MD)
Entity Type:Individual
Prefix:DR
First Name:SORBELLA
Middle Name:MAULIT
Last Name:GUILLERMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 KILANI AVE
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2102
Mailing Address - Country:US
Mailing Address - Phone:808-677-1433
Mailing Address - Fax:808-677-1676
Practice Address - Street 1:94-300 FARRINGTON HWY
Practice Address - Street 2:#F-8
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2648
Practice Address - Country:US
Practice Address - Phone:808-677-1433
Practice Address - Fax:808-677-1676
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8981207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07620701Medicaid
HIG16739Medicare UPIN
HI50727Medicare ID - Type Unspecified