Provider Demographics
NPI:1144828773
Name:ABOUT FACE KAILUA, LLC
Entity type:Organization
Organization Name:ABOUT FACE KAILUA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:I
Authorized Official - Last Name:BARTOLOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-343-6341
Mailing Address - Street 1:970 N. KALAHEA AVE
Mailing Address - Street 2:SUITE A-11
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:808-343-6341
Mailing Address - Fax:808-443-0297
Practice Address - Street 1:970 N. KALAHEA AVE
Practice Address - Street 2:SUITE A-11
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-343-6341
Practice Address - Fax:808-443-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty