Provider Demographics
NPI:1699814764
Name:PACPACO, WILFRED PATAO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:PATAO
Last Name:PACPACO
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 1:1860 ALA MOANA BLVD
Mailing Address - Street 2:UNIT # 600
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1632
Mailing Address - Country:US
Mailing Address - Phone:808-944-2722
Mailing Address - Fax:808-944-2722
Practice Address - Street 1:1860 ALA MOANA BLVD
Practice Address - Street 2:UNIT # 600
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1632
Practice Address - Country:US
Practice Address - Phone:808-944-2722
Practice Address - Fax:808-944-2722
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3318207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIJ043453OtherHMSA
HI039621-05Medicaid
HIMD3318OtherMD LICENSE
HI0000BDRKXMedicare ID - Type Unspecified
HIJ043453OtherHMSA