Provider Demographics
NPI:1780861229
Name:GATEWAY URGENT CARE CLINIC, L.L.C.
Entity Type:Organization
Organization Name:GATEWAY URGENT CARE CLINIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SORBELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUILLERMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-677-1433
Mailing Address - Street 1:94-378 PUPUPANI STREET
Mailing Address - Street 2:102
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2648
Mailing Address - Country:US
Mailing Address - Phone:808-677-1433
Mailing Address - Fax:808-677-1676
Practice Address - Street 1:94-378 PUPUPANI STREET
Practice Address - Street 2:102
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2648
Practice Address - Country:US
Practice Address - Phone:808-677-1433
Practice Address - Fax:808-677-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8981302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization