Provider Demographics
NPI:1851400634
Name:HAWAII CENTER FOR REGENERATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:HAWAII CENTER FOR REGENERATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:ROSELA
Authorized Official - Last Name:MANIQUIS-SMIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-933-3444
Mailing Address - Street 1:136A ULULANI STREET
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2946
Mailing Address - Country:US
Mailing Address - Phone:808-933-3444
Mailing Address - Fax:808-933-3433
Practice Address - Street 1:136A ULULANI STREET
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2946
Practice Address - Country:US
Practice Address - Phone:808-933-3444
Practice Address - Fax:808-933-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-10575208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00C022405-9OtherHAWAII MEDICAL SVC ASSOC
HI362562300OtherACS
HI248808-02Medicaid
HI248808-02Medicaid
HI362562300OtherACS
H93832Medicare UPIN
H55527Medicare PIN