Provider Demographics
NPI:1932259264
Name:NIP SAKAMOTO, CARLA JOYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:JOYCE
Last Name:NIP SAKAMOTO
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 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-536-9888
Mailing Address - Fax:808-585-8450
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 109
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-536-9888
Practice Address - Fax:808-585-8450
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI509416Medicaid
HIH50018Medicare ID - Type Unspecified
HI509416Medicaid