Provider Demographics
NPI:1730277716
Name:EMMA B AVILLA, MD, INC
Entity type:Organization
Organization Name:EMMA B AVILLA, MD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:B
Authorized Official - Last Name:AVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-842-1585
Mailing Address - Street 1:1728 DILLINGHAM BLVD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4017
Mailing Address - Country:US
Mailing Address - Phone:808-842-1585
Mailing Address - Fax:808-847-6951
Practice Address - Street 1:1728 DILLINGHAM BLVD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-842-1585
Practice Address - Fax:808-847-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10202207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08842801Medicaid
HIB221958OtherHMSA
HIG72610Medicare UPIN
HIH54099Medicare ID - Type Unspecified