Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | MDR-7274 | HI |
NPI | 1114456936 |
---|---|
Provider Name | Jasmin Domingo Reyes Moncada |
First Address | Honolulu, HI 96826-1032 |
Second Address | Honolulu, HI 96826-1032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 13/06/2017 |