Healthcare Provider Details

I. General information

NPI: 1790030161
Provider Name (Legal Business Name): ELIZABETH M. IGNACIO, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 801
HONOLULU HI
96813-2429
US

IV. Provider business mailing address

1221 KAPIOLANI BLVD STE 820
HONOLULU HI
96814-3503
US

V. Phone/Fax

Practice location:
  • Phone: 808-521-8170
  • Fax: 808-537-9195
Mailing address:
  • Phone: 808-524-5247
  • Fax: 808-521-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number13763
License Number StateHI

VIII. Authorized Official

Name: DAVID GRIFFITH
Title or Position: ADMINISTRATOR
Credential: MBA, CMPE
Phone: 808-521-8130