Provider Demographics
NPI:1255312401
Name:TOMITA, NATHAN P (DO)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:P
Last Name:TOMITA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-170 HUALALAI RD STE D216A
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1779
Mailing Address - Country:US
Mailing Address - Phone:808-313-8338
Mailing Address - Fax:808-313-8339
Practice Address - Street 1:75-170 HUALALAI RD STE D216A
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1779
Practice Address - Country:US
Practice Address - Phone:808-313-8338
Practice Address - Fax:808-313-8339
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013860208600000X
HIDOS1441208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114583911Medicaid
MI0257801385OtherBCBSM
MI114583911Medicaid
MION90020Medicare ID - Type Unspecified