Healthcare Provider Details

I. General information

NPI: 1366795635
Provider Name (Legal Business Name): WESTGATE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-370 PUPUPANI ST
WAIPAHU HI
96797-2657
US

IV. Provider business mailing address

94-370 PUPUPANI ST
WAIPAHU HI
96797-2657
US

V. Phone/Fax

Practice location:
  • Phone: 888-589-2259
  • Fax:
Mailing address:
  • Phone: 888-589-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD5016
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number14877
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD5016
License Number StateHI

VIII. Authorized Official

Name: LULUMAFUIE FIATOA
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 888-589-2259