Provider Demographics
NPI:1972671642
Name:S.SIRA,M.D.,FACOG,INC
Entity Type:Organization
Organization Name:S.SIRA,M.D.,FACOG,INC
Other - Org Name:SIRA,SANTAD,MD,FACOG,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTAD
Authorized Official - Middle Name:-
Authorized Official - Last Name:SIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-322-3434
Mailing Address - Street 1:79-7266 MAMALAHOA HWY
Mailing Address - Street 2:HONALO BUSINESS CENTER#4
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-7919
Mailing Address - Country:US
Mailing Address - Phone:808-322-3434
Mailing Address - Fax:808-322-4011
Practice Address - Street 1:79-7266 MAMALAHOA HWY
Practice Address - Street 2:HONALO BUSINESS CENTER#4
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7919
Practice Address - Country:US
Practice Address - Phone:808-322-3434
Practice Address - Fax:808-322-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI02682261Q00000X
CAA029663261Q00000X
OH37681261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03541901OtherKAISER
HI03541902Medicaid
HI03541902Medicaid
HI0000BDGZNMedicare ID - Type Unspecified