Provider Demographics
NPI:1639103070
Name:MALANA, GLENDA (MD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:MALANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1025 HOOMAALILI ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5954
Mailing Address - Country:US
Mailing Address - Phone:808-683-1026
Mailing Address - Fax:
Practice Address - Street 1:91-2139 FORT WEAVER RD STE 302
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3609
Practice Address - Country:US
Practice Address - Phone:775-219-6855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine