Provider Demographics
NPI:1508513136
Name:FLORA MEDINA-MANUEL, M.D., INC.
Entity Type:Organization
Organization Name:FLORA MEDINA-MANUEL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA-MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-845-7173
Mailing Address - Street 1:2153 N KING ST STE 325
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4560
Mailing Address - Country:US
Mailing Address - Phone:808-845-7173
Mailing Address - Fax:808-841-8599
Practice Address - Street 1:2153 N KING ST STE 325
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4560
Practice Address - Country:US
Practice Address - Phone:808-845-7173
Practice Address - Fax:808-845-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI618738Medicaid