Provider Demographics
NPI:1033277348
Name:LIVAUDAIS, FELICITAS B (MD)
Entity Type:Individual
Prefix:
First Name:FELICITAS
Middle Name:B
Last Name:LIVAUDAIS
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 1:1279 S KIHEI RD STE 120
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5222
Mailing Address - Country:US
Mailing Address - Phone:808-891-6800
Mailing Address - Fax:
Practice Address - Street 1:1279 S KIHEI RD STE 120
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-5222
Practice Address - Country:US
Practice Address - Phone:808-891-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11704208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000232041OtherHMSA BILLING NUMBER
HI505315-02Medicaid
HIG39830Medicare UPIN
HI505315-02Medicaid