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:
Health care specialties
| Specialty | Code | License # | 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 last year |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1356341002 | NPPES |
| Hawaii | MEDICAID | 07892401 | |
| Hawaii | Other | 020779-5 |
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