Provider Demographics
NPI:1194788265
Name:MORENO-CABRAL, CARLOS E (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:E
Last Name:MORENO-CABRAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 912
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2449
Mailing Address - Country:US
Mailing Address - Phone:808-524-5980
Mailing Address - Fax:808-526-0317
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 912
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2449
Practice Address - Country:US
Practice Address - Phone:808-524-5980
Practice Address - Fax:808-526-0317
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6684174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI053987Medicaid
HIE72699Medicare UPIN
HIH0000BDPTPMedicare ID - Type Unspecified