Provider Demographics
NPI:1699884304
Name:LUZ, BENILDA CASTILLO (MD)
Entity type:Individual
Prefix:DR
First Name:BENILDA
Middle Name:CASTILLO
Last Name:LUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BENILDA
Other - Middle Name:CASTILLO
Other - Last Name:LUZ-LLENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:94-307 FARRINGTON HWY
Mailing Address - Street 2:STE. B3
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2565
Mailing Address - Country:US
Mailing Address - Phone:808-677-5022
Mailing Address - Fax:808-677-8702
Practice Address - Street 1:94-307 FARRINGTON HWY
Practice Address - Street 2:STE. B3
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2565
Practice Address - Country:US
Practice Address - Phone:808-677-5022
Practice Address - Fax:808-677-8702
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI002398Medicaid