Provider Demographics
NPI:1982472338
Name:VANESSA H. EAGLIN, MD LLC
Entity Type:Organization
Organization Name:VANESSA H. EAGLIN, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:HULALI
Authorized Official - Last Name:EAGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-557-6261
Mailing Address - Street 1:180 KINOOLE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2827
Mailing Address - Country:US
Mailing Address - Phone:808-470-6754
Mailing Address - Fax:808-333-5120
Practice Address - Street 1:180 KINOOLE ST STE 202
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2827
Practice Address - Country:US
Practice Address - Phone:808-470-6754
Practice Address - Fax:808-333-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health