Healthcare Provider Details

I. General information

NPI: 1841402914
Provider Name (Legal Business Name): FREDERICK A. NITTA, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 PONAHAWAI ST SUITE 200
HILO HI
96720-2660
US

IV. Provider business mailing address

670 PONAHAWAI ST SUITE 200
HILO HI
96720-2660
US

V. Phone/Fax

Practice location:
  • Phone: 808-961-5922
  • Fax: 808-969-1924
Mailing address:
  • Phone: 808-961-5922
  • Fax: 808-969-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FREDERICK ALAN NITTA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-961-5922