Provider Demographics
NPI:1225111776
Name:AGULLANA, LEILA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:M
Last Name:AGULLANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 KAMOKILA BLVD
Mailing Address - Street 2:STE 197
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2014
Mailing Address - Country:US
Mailing Address - Phone:808-674-9600
Mailing Address - Fax:808-674-9700
Practice Address - Street 1:1001 KAMOKILA BLVD
Practice Address - Street 2:STE 197
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2014
Practice Address - Country:US
Practice Address - Phone:808-674-9600
Practice Address - Fax:808-674-9700
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-12344208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00C0245666OtherHMSA BILLING NUMBER
HI547945-04Medicaid
HI547945-04Medicaid
HII03653Medicare UPIN