| Gloria Eden G Domingo Md Llc | |
|
94-333 Waipahu Depot St # M6 Waipahu HI 96797-3012 | |
| (808) 677-5664 | |
| (808) 784-0147 |
| Full Name | Gloria Eden G Domingo Md Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 94-333 Waipahu Depot St # M6, Waipahu, Hawaii |
| Authorized Official Name and Position | Gloria Eden G Domingo (MD) |
| Authorized Official Contact | 8082224111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gloria Eden G Domingo Md Llc Po Box 30460 Honolulu HI 96820-0460 Ph: (808) 941-3863 | Gloria Eden G Domingo Md Llc 94-333 Waipahu Depot St # M6 Waipahu HI 96797-3012 Ph: (808) 677-5664 |
| NPI Number | 1194409284 |
|---|---|
| Provider Enumeration Date | 06/09/2023 |
| Last Update Date | 06/09/2023 |
| Medicare PECOS PAC ID | 8325580400 |
|---|---|
| Medicare Enrollment ID | O20240604002885 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194409284 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Gloria Eden G Domingo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205130655 PECOS PAC ID: 8123276722 Enrollment ID: I20120924000049 |
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