Doctor Name: | DR. RUSSELL G TACATA |
NPI Number: | 1356341002 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 9570 |
Business Practice Address: | 1619 Liliha Street #3 Honolulu, HI - 968173152 |
Business Phone Number: | 8085315454 |
Business Fax Number: | 8085315451 |
Mailing Address: | 1619 Liliha Street, #3 HONOLULU |
State: | HI |
Postal Code: | 968173152 |
Phone Number: | 8085315454 |
Fax Number: | 8085315451 |
NPI Enumeration Date: | 07/22/2005 |
NPI Last Update Date: | 01/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 9570 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |