Provider Demographics
NPI:1730944083
Name:AGNELA ISAIAS LLC
Entity type:Organization
Organization Name:AGNELA ISAIAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AGNELA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:ISAIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-472-9950
Mailing Address - Street 1:3779 KUMULANI PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1113
Mailing Address - Country:US
Mailing Address - Phone:858-472-9950
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3925
Practice Address - Country:US
Practice Address - Phone:808-488-8441
Practice Address - Fax:808-200-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty