Provider Demographics
NPI:1386050169
Name:ALII BARIATRIC CENTER
Entity type:Organization
Organization Name:ALII BARIATRIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINADOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GENIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, FAAFP
Authorized Official - Phone:808-329-3588
Mailing Address - Street 1:75-5995 KUAKINI HWY
Mailing Address - Street 2:SUITE 427
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2144
Mailing Address - Country:US
Mailing Address - Phone:808-329-3588
Mailing Address - Fax:808-329-3233
Practice Address - Street 1:75-5995 KUAKINI HWY
Practice Address - Street 2:SUITE 427
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2144
Practice Address - Country:US
Practice Address - Phone:808-329-3588
Practice Address - Fax:808-329-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8532208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1386754257OtherINDIVIDUAL NPI