Provider Demographics
NPI:1447346150
Name:BELMONTE, GLORIFIN LARDIZABAL (MD)
Entity type:Individual
Prefix:
First Name:GLORIFIN
Middle Name:LARDIZABAL
Last Name:BELMONTE
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 1:2239 N. SCHOOL STREET
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:808-791-9425
Mailing Address - Fax:808-847-1144
Practice Address - Street 1:2239 N. SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-791-9425
Practice Address - Fax:808-847-1144
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI MD 4661101YP2500X
HIMDHAWAII46612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI012561-03Medicaid
HI00A001326-6OtherHMSA
HIH0000BDLDCMedicare ID - Type UnspecifiedMD PROVIDER NUMBER
HI00A001326-6OtherHMSA