Provider Demographics
NPI:1306598065
Name:PERLITA BOLOSAN LAMPITOC MD INC
Entity type:Organization
Organization Name:PERLITA BOLOSAN LAMPITOC MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERLITA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAMPITOC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-671-8539
Mailing Address - Street 1:94-235 HANAWAI CIR STE 8
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3029
Mailing Address - Country:US
Mailing Address - Phone:808-671-8539
Mailing Address - Fax:808-671-1681
Practice Address - Street 1:94-235 HANAWAI CIR STE 8
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3029
Practice Address - Country:US
Practice Address - Phone:808-671-8539
Practice Address - Fax:808-671-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI016037Medicaid