Provider Demographics
NPI:1982726303
Name:PADERES, SISAR MEDIOR (MD)
Entity Type:Individual
Prefix:
First Name:SISAR
Middle Name:MEDIOR
Last Name:PADERES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 PIIKEA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-1840
Mailing Address - Country:US
Mailing Address - Phone:808-422-9828
Mailing Address - Fax:
Practice Address - Street 1:99-902 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3252
Practice Address - Country:US
Practice Address - Phone:808-484-5426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD - 4865208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice