Provider Demographics
NPI:1093879884
Name:ORTIZ-OMPHROY, GABRIELA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:MARIA
Last Name:ORTIZ-OMPHROY
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:PO BOX 31000
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96849-5550
Mailing Address - Country:US
Mailing Address - Phone:808-488-4342
Mailing Address - Fax:808-488-4151
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 118A
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5310
Practice Address - Country:US
Practice Address - Phone:808-488-4342
Practice Address - Fax:808-488-4151
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 12351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5392731-3Medicaid
HIH89747Medicare UPIN
HIH55672Medicare PIN