Provider Demographics
NPI:1861370702
Name:EDISON P ERORITA LLC
Entity type:Organization
Organization Name:EDISON P ERORITA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ERORITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-445-5741
Mailing Address - Street 1:355 AOLOA ST APT E201
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3043
Mailing Address - Country:US
Mailing Address - Phone:808-445-5741
Mailing Address - Fax:
Practice Address - Street 1:355 AOLOA ST APT E201
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3043
Practice Address - Country:US
Practice Address - Phone:808-445-5741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center