Provider Demographics
NPI:1003357765
Name:WARFIGHTER'S CLINIC
Entity Type:Organization
Organization Name:WARFIGHTER'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORIFUSA
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ANEGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:808-345-6832
Mailing Address - Street 1:91-1027 SHANGRILA ST
Mailing Address - Street 2:BLDG 1867
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2101
Mailing Address - Country:US
Mailing Address - Phone:808-345-6832
Mailing Address - Fax:
Practice Address - Street 1:91-1027 SHANGRILA ST
Practice Address - Street 2:BLDG 1867
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2101
Practice Address - Country:US
Practice Address - Phone:808-345-6832
Practice Address - Fax:808-674-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 13015204R00000X, 208VP0000X
HIPT 18152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty