Provider Demographics
NPI:1225126741
Name:GOZUN, FORTUNATA NARVAEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:FORTUNATA
Middle Name:NARVAEZ
Last Name:GOZUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-6390 KAPOLEI PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:808-691-8200
Mailing Address - Fax:808-677-1372
Practice Address - Street 1:91-6390 KAPOLEI PKWY STE 200
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-691-8200
Practice Address - Fax:808-677-1372
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI078638Medicaid
HI56794Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
HI078638Medicaid