Provider Demographics
NPI:1477305506
Name:WAILUKU INTERNAL MEDICINE CLINIC , LLC
Entity Type:Organization
Organization Name:WAILUKU INTERNAL MEDICINE CLINIC , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA CHARITO
Authorized Official - Middle Name:GONZALES
Authorized Official - Last Name:TERMULO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-269-3918
Mailing Address - Street 1:1063 LOWER MAIN ST STE C106
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-6035
Mailing Address - Country:US
Mailing Address - Phone:808-242-6478
Mailing Address - Fax:
Practice Address - Street 1:1063 LOWER MAIN ST STE C106
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-6035
Practice Address - Country:US
Practice Address - Phone:808-242-6478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center