Provider Demographics
NPI:1841563533
Name:BLUDOC PEDIATRICS, INC.
Entity type:Organization
Organization Name:BLUDOC PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AJOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-722-8792
Mailing Address - Street 1:95-993 UKUWAI ST
Mailing Address - Street 2:#2602
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-6948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95-993 UKUWAI ST
Practice Address - Street 2:#2602
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-6948
Practice Address - Country:US
Practice Address - Phone:808-722-8792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 14643282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren