Provider Demographics
NPI:1710935424
Name:POSA, IDALEE PIA CABALLERO (MD)
Entity Type:Individual
Prefix:
First Name:IDALEE PIA
Middle Name:CABALLERO
Last Name:POSA
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 1:45-549 PLUMERIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-6902
Mailing Address - Country:US
Mailing Address - Phone:808-775-7204
Mailing Address - Fax:808-775-7204
Practice Address - Street 1:45-549 PLUMERIA ST
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6902
Practice Address - Country:US
Practice Address - Phone:808-775-7204
Practice Address - Fax:808-775-9404
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25436207Q00000X
HIMD-18468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD-18468OtherSTATE LICENSE
HIE12536OtherCONTROLLED SUBSTANCES
ORMD25436OtherSTATE LICENSE
ORMD25436OtherSTATE LICENSE
HIE12536OtherCONTROLLED SUBSTANCES
ORMD25436OtherSTATE LICENSE