1780896704 NPI number — CHRISTINA COLLINS LLC

Table of content: (NPI 1780896704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780896704 NPI number — CHRISTINA COLLINS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTINA COLLINS LLC
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:
Provider Other Organization Name Type Code:
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:
1780896704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75-5759 KUAKINI HWY
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
KAILUA KONA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96740-1726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-331-2300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75-5759 KUAKINI HWY
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
KAILUA KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-331-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
808-331-2300

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  MD13205 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X , with the licence number: MD13205 , 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)

  • Identifier: 566664-02 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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