Provider Demographics
NPI:1326600735
Name:DANIEL GALLARES MD LLC
Entity Type:Organization
Organization Name:DANIEL GALLARES MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-993-6950
Mailing Address - Street 1:PO BOX 235061
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-3501
Mailing Address - Country:US
Mailing Address - Phone:619-993-6950
Mailing Address - Fax:
Practice Address - Street 1:70 OLONA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5017
Practice Address - Country:US
Practice Address - Phone:808-731-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty