=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114010709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GODOFREDO BARCENA BACLIG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 02/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 N KUAKINI ST SUITE 1112
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-6300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-524-5024
-----------------------------------------------------
Fax | 808-524-5715
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 405 N KUAKINI ST SUITE 1112
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-6300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-524-5024
-----------------------------------------------------
Fax | 808-524-5715
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 8967
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------