Provider Demographics
NPI:1790772572
Name:ISAIAS, AGNELA TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:AGNELA
Middle Name:TERESA
Last Name:ISAIAS
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 1:3779 KUMULANI PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1113
Mailing Address - Country:US
Mailing Address - Phone:858-472-9950
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 211
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3972
Practice Address - Country:US
Practice Address - Phone:808-488-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-23703208000000X
CA82912208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051524720OtherBCBS PROVIDER NUMBER
AL009971875Medicaid
ALI22024Medicare UPIN