Healthcare Provider Details

I. General information

NPI: 1629307897
Provider Name (Legal Business Name): DR. STEPHEN A TAREK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 E MANOA RD SUITE 1-205
HONOLULU HI
96822-1858
US

IV. Provider business mailing address

2851 E MANOA RD SUITE 1-205
HONOLULU HI
96822-1858
US

V. Phone/Fax

Practice location:
  • Phone: 808-988-6113
  • Fax: 808-988-5637
Mailing address:
  • Phone: 808-988-6113
  • Fax: 808-988-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MS. LORNA MERCADO
Title or Position: OFFICE MANAGER
Credential:
Phone: 808-988-6113