Provider Demographics
NPI:1710726146
Name:KAPOLEI PRIMARY CARE CLINIC
Entity type:Organization
Organization Name:KAPOLEI PRIMARY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARIFE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:520-982-7587
Mailing Address - Street 1:840 KAKALA ST APT 405
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-4608
Mailing Address - Country:US
Mailing Address - Phone:808-400-3899
Mailing Address - Fax:808-501-2122
Practice Address - Street 1:91-710 FARRINGTON HWY STE A120
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2659
Practice Address - Country:US
Practice Address - Phone:520-982-7587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care