Provider Demographics
NPI:1912050501
Name:LOVE, DEBORAH CANDACE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:CANDACE
Last Name:LOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68-155 AU ST APT 204
Mailing Address - Street 2:
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791-9457
Mailing Address - Country:US
Mailing Address - Phone:808-622-5556
Mailing Address - Fax:808-621-4594
Practice Address - Street 1:302 CALIFORNIA AVE STE 208
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1841
Practice Address - Country:US
Practice Address - Phone:808-622-5556
Practice Address - Fax:808-621-4594
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4421207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01401301Medicaid
HIH55865Medicare ID - Type Unspecified
HI01401301Medicaid