Provider Demographics
NPI:1396730594
Name:MONIZ, KATHLEEN LUANA DURANTE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LUANA DURANTE
Last Name:MONIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:LUANA
Other - Last Name:DURANTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:291 KAKAHIAKA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3461
Mailing Address - Country:US
Mailing Address - Phone:808-226-4116
Mailing Address - Fax:808-262-4444
Practice Address - Street 1:291 KAKAHIAKA ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3461
Practice Address - Country:US
Practice Address - Phone:808-226-4116
Practice Address - Fax:808-262-4444
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5228208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01858901Medicaid
HI01858901Medicaid
HIC98750Medicare UPIN