Provider Demographics
NPI:1831872126
Name:RUSSELL G TACATA MD
Entity type:Organization
Organization Name:RUSSELL G TACATA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:G
Authorized Official - Last Name:TACATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-531-5454
Mailing Address - Street 1:1619 LILIHA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3152
Mailing Address - Country:US
Mailing Address - Phone:808-531-5454
Mailing Address - Fax:808-531-5451
Practice Address - Street 1:1619 LILIHA ST STE 3
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3152
Practice Address - Country:US
Practice Address - Phone:808-531-5454
Practice Address - Fax:808-531-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center