Provider Demographics
NPI:1255371027
Name:TEXEIRA, CORALIE A K (MD)
Entity type:Individual
Prefix:DR
First Name:CORALIE
Middle Name:A K
Last Name:TEXEIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:C.
Other - Middle Name:KANANI
Other - Last Name:TEXEIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:91-2139 FORT WEAVER ROAD
Mailing Address - Street 2:213
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:808-677-8008
Mailing Address - Fax:808-677-8007
Practice Address - Street 1:91-2139 FORT WEAVER RD
Practice Address - Street 2:SUITE 213
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3607
Practice Address - Country:US
Practice Address - Phone:808-677-8008
Practice Address - Fax:808-677-8007
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13563208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH105198OtherMEDICARE PTAN
HIH105056OtherGROUP MEDICARE PTAN