Organization
MARIA CARIDAD ILAR-REVILLA COMMUNITY HEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIA CARIDAD ILAR-REVILLA M.D. (OWNER)
(808) 677-5832
Entity
Organization
Contact information
Practice address
94-866 MOLOALO ST STE 1B, WAIPAHU, HI 96797-3354
(808) 677-5832
(808) 671-9109
Mailing address
94-866 MOLOALO ST STE 1B, WAIPAHU, HI 96797-3354
(808) 677-5832
(808) 671-9109
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
9394
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078033-01
—
HI
Enumeration date
10/22/2010
Last updated
10/15/2012
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