Tacata, Russell G

Tacata, Russell G is an individual health care provider with primary practice located at 1619 Liliha Street #3, Honolulu HI 96817-3152. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Tacata, Russell G can be contacted via phone (808) 531-5454.

Contact Information

Primary practice address
1619 Liliha Street #3 Honolulu HI 96817-3152
Phone: (808) 531-5454
Fax: (808) 531-5451
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 9570 Hawaii

Profile Details

NPI number 1356341002
LBN Legal business name Tacata, Russell G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 22nd, 2005
Last updated Aug 3rd, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356341002 NPPES
Hawaii MEDICAID 07892401
Hawaii Other 020779-5

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