Individual
ALYSSA MARIE TAGATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
91-213 KAIELEELE PL, EWA BEACH, HI 96706-4617
(808) 238-9011
Mailing address
91-213 KAIELEELE PL, EWA BEACH, HI 96706-4617
(808) 238-9011
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
18962
HI
Other
Enumeration date
04/25/2019
Last updated
04/25/2019
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