Provider Demographics
NPI:1790030161
Name:ELIZABETH M. IGNACIO, M.D., LLC
Entity Type:Organization
Organization Name:ELIZABETH M. IGNACIO, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CMPE
Authorized Official - Phone:808-521-8130
Mailing Address - Street 1:1221 KAPIOLANI BLVD
Mailing Address - Street 2:STE 820
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3503
Mailing Address - Country:US
Mailing Address - Phone:808-524-5247
Mailing Address - Fax:808-521-8185
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:STE 801
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-521-8170
Practice Address - Fax:808-537-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13763207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH91006Medicare UPIN