Provider Demographics
NPI:1639781123
Name:MONTALBO, BRYCE (APRN)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:MONTALBO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-446 KAAWELA PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1414
Mailing Address - Country:US
Mailing Address - Phone:808-351-2275
Mailing Address - Fax:
Practice Address - Street 1:500 ALA MOANA BLVD STE 6230
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4929
Practice Address - Country:US
Practice Address - Phone:808-524-6115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty