Provider Demographics
NPI:1104553908
Name:SILDORA, MONALICE A
Entity type:Individual
Prefix:
First Name:MONALICE
Middle Name:A
Last Name:SILDORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1052 KANIO ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-368-2124
Mailing Address - Fax:808-200-4828
Practice Address - Street 1:91-1052 KANIO ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3221
Practice Address - Country:US
Practice Address - Phone:808-368-2124
Practice Address - Fax:808-200-4828
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-25
Deactivation Date:2022-08-02
Deactivation Code:
Reactivation Date:2022-08-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal Dialysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
883496408OtherIRS