1508273012 NPI number — ELENA KAMAKANIKAILIALOHA DA SILVA

Table of content: ELENA KAMAKANIKAILIALOHA DA SILVA (NPI 1508273012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508273012 NPI number — ELENA KAMAKANIKAILIALOHA DA SILVA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DA SILVA
Provider First Name:
ELENA
Provider Middle Name:
KAMAKANIKAILIALOHA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DA SILVA
Provider Other First Name:
MAKANI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSPAS, MPH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508273012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 CLUB DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94592-1187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-638-5205
Provider Business Mailing Address Fax Number:
707-638-5225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 COURAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94533-6733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-784-2001
Provider Business Practice Location Address Fax Number:
707-784-1494
Provider Enumeration Date:
07/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA51657 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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