Provider Demographics
NPI:1295154904
Name:BUENAVENTURA E. REALICA
Entity type:Organization
Organization Name:BUENAVENTURA E. REALICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:BUENAVENTURA
Authorized Official - Middle Name:E
Authorized Official - Last Name:REALICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-677-5664
Mailing Address - Street 1:94-239 WAIPAHU DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3056
Mailing Address - Country:US
Mailing Address - Phone:808-677-5664
Mailing Address - Fax:808-677-1010
Practice Address - Street 1:94-239 WAIPAHU DEPOT ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3056
Practice Address - Country:US
Practice Address - Phone:808-677-5664
Practice Address - Fax:808-677-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty