Provider Demographics
NPI:1609095595
Name:MARINA A. BADUA, M.D., INC.
Entity Type:Organization
Organization Name:MARINA A. BADUA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:AGUIRAN
Authorized Official - Last Name:BADUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-536-1754
Mailing Address - Street 1:1712 LILIHA ST
Mailing Address - Street 2:202
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5410
Mailing Address - Country:US
Mailing Address - Phone:808-536-1754
Mailing Address - Fax:808-536-0315
Practice Address - Street 1:1712 LILIHA ST
Practice Address - Street 2:202
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5410
Practice Address - Country:US
Practice Address - Phone:808-536-1754
Practice Address - Fax:808-536-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3187305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00Y0042021OtherHMSA
HI03829002Medicaid
HIC98906Medicare UPIN
C98906Medicare UPIN
HI03829002Medicaid