Provider Demographics
NPI:1932303732
Name:WENCESLAO, STELLA M (MD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:M
Last Name:WENCESLAO
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 1:691 ILALO ST
Mailing Address - Street 2:MEDICAL EDUCATION BUILDING
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:651 ILALO ST
Practice Address - Street 2:SUITE #401A
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5525
Practice Address - Country:US
Practice Address - Phone:808-692-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR 5259207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology