Provider Demographics
NPI:1649077447
Name:MILILANI GASTRO, LLC
Entity type:Organization
Organization Name:MILILANI GASTRO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYSON
Authorized Official - Middle Name:C
Authorized Official - Last Name:CABUDOY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:808-722-4028
Mailing Address - Street 1:95-390 KUAHELANI AVE UNIT 4A-1
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1192
Mailing Address - Country:US
Mailing Address - Phone:808-272-1889
Mailing Address - Fax:888-220-7388
Practice Address - Street 1:1245 KUALA ST STE 102A
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3900
Practice Address - Country:US
Practice Address - Phone:808-272-1889
Practice Address - Fax:888-220-7388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILILANI GASTRO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-27
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty