Provider Demographics
NPI:1902093305
Name:MADAMBA, JOSEPH RYAN MATEO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH RYAN
Middle Name:MATEO
Last Name:MADAMBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 LILIHA ST
Mailing Address - Street 2:STE 203
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5410
Mailing Address - Country:US
Mailing Address - Phone:808-523-7955
Mailing Address - Fax:
Practice Address - Street 1:1712 LILIHA ST
Practice Address - Street 2:STE 203
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5410
Practice Address - Country:US
Practice Address - Phone:808-523-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD15622207R00000X
CAA108723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine