Healthcare Provider Details

I. General information

NPI: 1225061674
Provider Name (Legal Business Name): ELIZABETH M IGNACIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S KING ST SUITE 401
HONOLULU HI
96814-1701
US

IV. Provider business mailing address

1010 S KING ST SUITE 401
HONOLULU HI
96814-1701
US

V. Phone/Fax

Practice location:
  • Phone: 808-521-8170
  • Fax: 808-521-8127
Mailing address:
  • Phone: 808-521-8170
  • Fax: 808-521-8127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD13763
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: