Provider Demographics
NPI:1114258423
Name:TAETUNA, PEPE F (LMT)
Entity Type:Individual
Prefix:MISS
First Name:PEPE
Middle Name:F
Last Name:TAETUNA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1049 MIKOHU ST APT 11D
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3817
Mailing Address - Country:US
Mailing Address - Phone:808-699-9023
Mailing Address - Fax:
Practice Address - Street 1:94-750 HIKIMOE ST STE C
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3351
Practice Address - Country:US
Practice Address - Phone:808-671-4433
Practice Address - Fax:808-676-3006
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI507174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist