Provider Demographics
NPI:1972540789
Name:GILIBERT, STEPHANIE GOYENA (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GOYENA
Last Name:GILIBERT
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 1:1520 LILIHA ST STE 601
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3564
Mailing Address - Country:US
Mailing Address - Phone:808-523-0445
Mailing Address - Fax:808-356-3380
Practice Address - Street 1:1520 LILIHA ST STE 601
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3564
Practice Address - Country:US
Practice Address - Phone:808-523-0445
Practice Address - Fax:808-356-3380
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-22582207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11556812OtherCAQH
NJ0104311Medicaid
I51526Medicare UPIN
DE1000039786Medicaid
MD036MO430Medicare PIN
DE02153DC13Medicare PIN