| |
40 Aulike St Suite 411 Kailua HI 96734-2758 | |
(808) 341-4328 | |
(877) 348-8227 |
Full Name | |
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Speciality | Psychologist |
Location | 40 Aulike St, Kailua, Hawaii |
Authorized Official Name and Position | Elizabeth Keolani Taitano (OWNER) |
Authorized Official Contact | 8083414328 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 884 Kailua HI 96734-0884 Ph: (808) 341-4328 | 40 Aulike St Suite 411 Kailua HI 96734-2758 Ph: (808) 341-4328 |
NPI Number | 1851703607 |
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Provider Enumeration Date | 05/28/2014 |
Last Update Date | 02/16/2017 |
Medicare PECOS PAC ID | 3971729948 |
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Medicare Enrollment ID | O20140728002086 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851703607 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
Provider Name | Elizabeth K Taitano |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1972934099 PECOS PAC ID: 6507082575 Enrollment ID: I20140728002182 |
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