Provider Demographics
NPI:1568536787
Name:MMD
Entity Type:Organization
Organization Name:MMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALTAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-677-4969
Mailing Address - Street 1:94-904 KUAKAHI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2808
Mailing Address - Country:US
Mailing Address - Phone:808-677-4969
Mailing Address - Fax:808-677-4969
Practice Address - Street 1:94-904 KUAKAHI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2808
Practice Address - Country:US
Practice Address - Phone:808-677-4969
Practice Address - Fax:808-677-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW0423010802332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies