Provider Demographics
NPI:1740412600
Name:VIGILANCE GROUP,LLC
Entity Type:Organization
Organization Name:VIGILANCE GROUP,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CAMERINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-295-9100
Mailing Address - Street 1:1874 LAUKAHI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1361
Mailing Address - Country:US
Mailing Address - Phone:808-295-9100
Mailing Address - Fax:808-440-5605
Practice Address - Street 1:1874 LAUKAHI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1361
Practice Address - Country:US
Practice Address - Phone:808-295-9100
Practice Address - Fax:808-440-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIM 8523207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI581563Medicaid
HI581563Medicaid
HI101620Medicare PIN