Provider Demographics
NPI:1750407284
Name:TADIO, EKELA TADIO
Entity type:Individual
Prefix:MS
First Name:EKELA
Middle Name:TADIO
Last Name:TADIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 KAMEHAMEHA AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2855
Mailing Address - Country:US
Mailing Address - Phone:808-990-1039
Mailing Address - Fax:
Practice Address - Street 1:90 KAMEHAMEHA AVE STE 10
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2855
Practice Address - Country:US
Practice Address - Phone:808-990-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT#6831171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor