Provider Demographics
NPI:1912548660
Name:AKAMAI ONLINE CLINIC LLC
Entity Type:Organization
Organization Name:AKAMAI ONLINE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRILLS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-344-0967
Mailing Address - Street 1:1154 ULUOPIHI LOOP
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4360
Mailing Address - Country:US
Mailing Address - Phone:808-344-0967
Mailing Address - Fax:
Practice Address - Street 1:1154 ULUOPIHI LOOP
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4360
Practice Address - Country:US
Practice Address - Phone:808-344-0967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service