Provider Demographics
NPI:1497800072
Name:FIATOA, LULUMAFUIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LULUMAFUIE
Middle Name:
Last Name:FIATOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 N SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-2537
Mailing Address - Country:US
Mailing Address - Phone:808-847-0487
Mailing Address - Fax:808-847-0576
Practice Address - Street 1:2219 N SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2537
Practice Address - Country:US
Practice Address - Phone:808-847-0487
Practice Address - Fax:808-847-0576
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-5016208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01723602Medicaid