Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 18143 | HI |
N | 208000000X | Pediatrician | R73239 | AZ |
NPI | 1003178971 |
---|---|
Provider Name | Marissa Helene Fakaosita |
First Address | Honolulu, HI 96826-1001 |
Second Address | Honolulu, HI 96826-1001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2012 |
Last Update Date | 09/06/2015 |