Provider Demographics
NPI:1902975683
Name:TABA, MARTI Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTI
Middle Name:Y
Last Name:TABA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:602 KAILUA RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2841
Mailing Address - Country:US
Mailing Address - Phone:808-263-9100
Mailing Address - Fax:808-263-9120
Practice Address - Street 1:602 KAILUA RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2841
Practice Address - Country:US
Practice Address - Phone:808-263-9100
Practice Address - Fax:808-263-9120
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2010-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-11432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI499617Medicaid
HI0000229765OtherHMSA
HI2820444OtherUHA
HIH36671Medicare UPIN
HI2820444OtherUHA