Individual provider Active NPI

Marivic Cristobal Raymundo, M.D.

  • Pediatrics Physician
  • Honolulu, HI
National Provider Identifier
1013075852
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD-20471 Issued in HI
Practice address
915 N King St
Honolulu, HI 96817-4544
Phone
(808) 848-1438
NPI assigned
Dec 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0101230921 VA
Pediatrics Physician 208000000X MD-20471 HI Primary

Addresses

Primary practice location

915 N King St
Honolulu, HI 96817-4544

Mailing address

824 Crescent Trce
Chesapeake, VA 23320-3593
Phone (757) 580-6938

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240601000316 HI Practitioner - Pediatric Medicine 3870035173 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101230921VAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kalihi Palama Health Center CurrentSince Apr 17, 2024 Accepting new patients
Kalihi Palama Health Center CurrentSince Apr 17, 2024 Accepting new patients

Locations

915 N King St
Honolulu, HI 96817
Phone (808) 848-1438

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1013075852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 CRESCENT TRCE",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203593",
            "telephone_number": "757-580-6938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 N KING ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968174544",
            "telephone_number": "808-848-1438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAYMUNDO",
        "first_name": "MARIVIC",
        "middle_name": "CRISTOBAL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101230921",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "HI",
            "license": "MD-20471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.