Provider Demographics
NPI:1720030695
Name:FRATTARELLI, LEIGHANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEIGHANN
Middle Name:
Last Name:FRATTARELLI
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 1:407 ULUNIU ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2519
Mailing Address - Country:US
Mailing Address - Phone:808-262-0544
Mailing Address - Fax:808-262-3744
Practice Address - Street 1:407 ULUNIU ST
Practice Address - Street 2:SUITE 312
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2519
Practice Address - Country:US
Practice Address - Phone:808-262-0544
Practice Address - Fax:808-262-3744
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI495003-09Medicaid
HI495003-08Medicaid
HI495003-08Medicaid