| Randall J. Nitta, Md, Llc | |
|
98-1247 Kaahumanu St Ste 306 Aiea HI 96701-5301 | |
| (808) 484-2904 | |
| (808) 484-2864 |
| Full Name | Randall J. Nitta, Md, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 98-1247 Kaahumanu St Ste 306, Aiea, Hawaii |
| Authorized Official Name and Position | Randall Jiro Nitta (MEMBER) |
| Authorized Official Contact | 8082604404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Randall J. Nitta, Md, Llc 98-1247 Kaahumanu St Ste 306 Aiea HI 96701-5301 Ph: (808) 260-4404 | Randall J. Nitta, Md, Llc 98-1247 Kaahumanu St Ste 306 Aiea HI 96701-5301 Ph: (808) 484-2904 |
| NPI Number | 1134553597 |
|---|---|
| Provider Enumeration Date | 08/21/2013 |
| Last Update Date | 06/25/2019 |
| Medicare PECOS PAC ID | 7719116383 |
|---|---|
| Medicare Enrollment ID | O20140130000296 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134553597 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 9319 (Hawaii) | Primary |
| Provider Name | Randall J Nitta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588757066 PECOS PAC ID: 1658394804 Enrollment ID: I20060113000265 |
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