Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | MD-10677 | HI |
NPI | 1104911429 |
---|---|
Provider Name | Ms. Ritabelle Fernandes |
First Address | Honolulu, HI 96817-4544 |
Second Address | Honolulu, HI 96819-2539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 26/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000231431 | HMSA - BLUE CROSS (01) | HI |
0000992101 | (05) | HI |
005005210 | ALOHACARE (01) | HI |
H56111 | (02) | HI |
MD10677 | MDX (01) | HI |