Provider Demographics
NPI:1437483062
Name:RACHEL TORTOLINI MD,LLC
Entity Type:Organization
Organization Name:RACHEL TORTOLINI MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:REQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:808-531-7878
Mailing Address - Street 1:91-896 MAKULE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2543
Mailing Address - Country:US
Mailing Address - Phone:808-689-4414
Mailing Address - Fax:808-689-7115
Practice Address - Street 1:91-896 MAKULE RD STE 102
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2543
Practice Address - Country:US
Practice Address - Phone:808-689-4414
Practice Address - Fax:808-689-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-7682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI093740Medicaid
HIF21931Medicare UPIN