Gloria Eden G Domingo MD LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

GLORIA EDEN G DOMINGO MD LLC

Practice address

94-333 Waipahu Depot St # M6
Waipahu, HI 96797-3012

Phone

(808) 677-5664

Fax

(808) 784-0147

NPI assigned

Jun 9, 2023

Organization subpart

No

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

Authorized official

Name

Gloria Eden G Domingo, MDNPI 1205130655

Title

MD

Phone

(808) 222-4111

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gloria Eden Guerrero Domingo, MD

  • Family Medicine Physician
  • Waipahu, HI
  • NPI 1205130655
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1686268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686268800000",
    "number": "1194409284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30460",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968200460",
            "telephone_number": "808-941-3863",
            "fax_number": "808-949-0483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94-333 WAIPAHU DEPOT ST # M6",
            "city": "WAIPAHU",
            "state": "HI",
            "postal_code": "967973012",
            "telephone_number": "808-677-5664",
            "fax_number": "808-784-0147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLORIA EDEN G DOMINGO MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-09",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A",
        "authorized_official_last_name": "DOMINGO",
        "authorized_official_first_name": "GLORIA EDEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "808-222-4111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiana Gibson
• Jamila Giles
• Lahela Giles
• Alisha Kaede Ginoza
• Michael Phillip Glazer, RBT
• Lauren Glover-Alejado, PHARMD
• Cherise Go, RD, LD
• Sadie Go
• Tyler Niko Godinet, PHARMD
• Lee Nakamura Goerner, MD

• Primary Care Clinic/Center in Waipahu, HI
• Providers in Waipahu, HI by specialty
• Primary Care Clinic/Center in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.