Provider Demographics
NPI:1710388624
Name:LULUMAFUIE FIATOA, M.D. LLC
Entity Type:Organization
Organization Name:LULUMAFUIE FIATOA, M.D. LLC
Other - Org Name:MANA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LULUMAFUIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIATOA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-779-1169
Mailing Address - Street 1:PO BOX 17793
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-0793
Mailing Address - Country:US
Mailing Address - Phone:808-779-1169
Mailing Address - Fax:
Practice Address - Street 1:94-307 FARRINGTON HWY
Practice Address - Street 2:B-01
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2565
Practice Address - Country:US
Practice Address - Phone:808-847-0487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD5016208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00J0018448OtherHMSA PROVIDER NUMBER
HI01723602Medicaid