Provider Demographics
NPI:1235170689
Name:DAVIDE, CAROLINA DOMINICA (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:DOMINICA
Last Name:DAVIDE
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 1:95-1099 KOOLANI DR
Mailing Address - Street 2:#249
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5920
Mailing Address - Country:US
Mailing Address - Phone:808-291-0249
Mailing Address - Fax:
Practice Address - Street 1:85-910 FARRINGTON HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2651
Practice Address - Country:US
Practice Address - Phone:808-696-4044
Practice Address - Fax:808-696-4009
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIG-84408Medicare UPIN