Provider Demographics
NPI:1386721009
Name:PRATHER, LYLA CACHOLA (MD)
Entity type:Individual
Prefix:DR
First Name:LYLA
Middle Name:CACHOLA
Last Name:PRATHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 KALIHI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4069
Mailing Address - Country:US
Mailing Address - Phone:808-845-9955
Mailing Address - Fax:808-845-1783
Practice Address - Street 1:936 KALIHI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4069
Practice Address - Country:US
Practice Address - Phone:808-845-9955
Practice Address - Fax:808-845-1783
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI569593Medicaid
HI569593Medicaid
HI100735Medicare UPIN