Individual
DERYLL U AMBROCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1329 LUSITANA ST, SUITE 804, HONOLULU, HI 96813-2429
(808) 531-7111
(808) 528-5507
Mailing address
1329 LUSITANA ST, SUITE 804, HONOLULU, HI 96813-2429
(808) 531-7111
(808) 528-5507
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
0101242738
VA
207RR0500X
Rheumatology Physician
Primary
MD-15066
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A0285294
HMSA BILLING NUMBER
HI
05
—
635948-01
—
HI
Enumeration date
05/03/2007
Last updated
08/27/2010
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