Provider Demographics
NPI:1982042453
Name:BRIAN MANJARRES MD CORPORATION
Entity Type:Organization
Organization Name:BRIAN MANJARRES MD CORPORATION
Other - Org Name:HANA PONO CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MANJARRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-990-6355
Mailing Address - Street 1:3857 BIRCH ST
Mailing Address - Street 2:SUITE 605
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2616
Mailing Address - Country:US
Mailing Address - Phone:949-783-3600
Mailing Address - Fax:949-783-3602
Practice Address - Street 1:1401 S BERETANIA ST
Practice Address - Street 2:SUITE 450
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1870
Practice Address - Country:US
Practice Address - Phone:808-537-6688
Practice Address - Fax:808-537-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD16980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHD985AMedicare PIN