Provider Demographics
NPI:1407134828
Name:CHILDRENS ENDOCRINOLOGY CLINIC LLC
Entity Type:Organization
Organization Name:CHILDRENS ENDOCRINOLOGY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEERA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAMAYYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-325-9484
Mailing Address - Street 1:PO BOX 25490
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-0490
Mailing Address - Country:US
Mailing Address - Phone:808-536-0300
Mailing Address - Fax:808-536-0320
Practice Address - Street 1:75-5591 PALANI RD
Practice Address - Street 2:STE 2002
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3631
Practice Address - Country:US
Practice Address - Phone:808-325-9484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-159302080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF19166Medicare UPIN