Provider Demographics
NPI: | 1306954847 |
---|---|
Name: | MANIQUIS-SMIGEL, LIZA R (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | LIZA |
Middle Name: | R |
Last Name: | MANIQUIS-SMIGEL |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | LIZA |
Other - Middle Name: | ROSELA |
Other - Last Name: | MANIQUIS |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 136A ULULANI ST |
Mailing Address - Street 2: | |
Mailing Address - City: | HILO |
Mailing Address - State: | HI |
Mailing Address - Zip Code: | 96720-2946 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 808-933-3444 |
Mailing Address - Fax: | 808-933-3433 |
Practice Address - Street 1: | 136A ULULANI ST |
Practice Address - Street 2: | |
Practice Address - City: | HILO |
Practice Address - State: | HI |
Practice Address - Zip Code: | 96720-2946 |
Practice Address - Country: | US |
Practice Address - Phone: | 808-933-3444 |
Practice Address - Fax: | 808-933-3433 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-08-25 |
Last Update Date: | 2007-10-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
HI | MD 10575 | 208100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
HI | 362562300 | Other | ACS |
HI | 00C022405-9 | Other | HAWAII MEDICAL SVC ASSOC |
HI | 248808-04 | Medicaid | |
HI | H93832 | Medicare UPIN | |
HI | H55528 | Medicare PIN |