Basic Information
| Provider Information | |||||||||
| NPI: | 1750547006 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELTON | ||||||||
| FirstName: | DIANA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 ULUNIU ST | ||||||||
| Address2: | 411 | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082637203 | ||||||||
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| Practice Location | |||||||||
| Address1: | 407 ULUNIU ST | ||||||||
| Address2: | 411 | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082637203 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2008 | ||||||||
| LastUpdateDate: | 06/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD-18190 | HI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110084039A | 05 | MA | MEDICAID |