1982042453 NPI number — BRIAN MANJARRES MD CORPORATION

Table of content: (NPI 1982042453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982042453 NPI number — BRIAN MANJARRES MD CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN MANJARRES MD CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HANA PONO CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982042453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3857 BIRCH ST
Provider Second Line Business Mailing Address:
SUITE 605
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660-2616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-783-3600
Provider Business Mailing Address Fax Number:
949-783-3602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 S BERETANIA ST
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-537-6688
Provider Business Practice Location Address Fax Number:
808-537-6689
Provider Enumeration Date:
06/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MANJARRES
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
415-990-6355

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD16980 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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