Provider Demographics
NPI:1871665810
Name:MEDINA-MANUEL, FLORA GADI (MD)
Entity Type:Individual
Prefix:DR
First Name:FLORA
Middle Name:GADI
Last Name:MEDINA-MANUEL
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 1:2153 N KING ST STE 325
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4560
Mailing Address - Country:US
Mailing Address - Phone:808-845-7173
Mailing Address - Fax:808-841-8599
Practice Address - Street 1:2153 N KING ST STE 325
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4560
Practice Address - Country:US
Practice Address - Phone:808-845-7173
Practice Address - Fax:808-841-8599
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI04080174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00346401Medicaid
HI00C0002729OtherPROVIDER'S NUMBER