=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083483994
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSISTING PHYSICIANS AND THE COMMUNITY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2023
-----------------------------------------------------
Last Update Date | 12/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2653 HUAPALA ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96822-1653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-927-3539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2855 E MANOA RD STE 105
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96822-1854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER-MANAGER
-----------------------------------------------------
Name | TARYN OTAGAKI
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 808-927-3539
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------