Provider Demographics
NPI:1831341213
Name:CACHOLA MEDICAL CLINIC
Entity type:Organization
Organization Name:CACHOLA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERLINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CACHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-845-9955
Mailing Address - Street 1:936 KALIHI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4069
Mailing Address - Country:US
Mailing Address - Phone:808-845-9955
Mailing Address - Fax:808-845-1783
Practice Address - Street 1:936 KALIHI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4069
Practice Address - Country:US
Practice Address - Phone:808-845-9955
Practice Address - Fax:808-845-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI569593Medicaid
HI03439601Medicaid
HI03439601Medicaid
0000BDCSGMedicare PIN
F02262Medicare UPIN
HI569593Medicaid