Provider Demographics
NPI:1922278969
Name:BENILDA C. LUZ-LLENA, M.D. INC.
Entity Type:Organization
Organization Name:BENILDA C. LUZ-LLENA, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENILDA
Authorized Official - Middle Name:CASTILLO
Authorized Official - Last Name:LUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-677-5022
Mailing Address - Street 1:94-307 FARRINGTON HWY
Mailing Address - Street 2:STE. B3
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2565
Mailing Address - Country:US
Mailing Address - Phone:808-677-5022
Mailing Address - Fax:808-677-8702
Practice Address - Street 1:94-307 FARRINGTON HWY
Practice Address - Street 2:STE. B3
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2565
Practice Address - Country:US
Practice Address - Phone:808-677-5022
Practice Address - Fax:808-677-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI20192Medicaid
HI0000213926OtherHMSA