1194952457 NPI number — MRS. MIRIAM JESSIE SEITZ M.D.

Table of content: MRS. MIRIAM JESSIE SEITZ M.D. (NPI 1194952457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194952457 NPI number — MRS. MIRIAM JESSIE SEITZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEITZ
Provider First Name:
MIRIAM
Provider Middle Name:
JESSIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENTLEY-TAYLOR
Provider Other First Name:
MIRIAM
Provider Other Middle Name:
JESSIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194952457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 17460
Provider Second Line Business Mailing Address:
915 N KING ST
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-845-8578
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 N KING ST
Provider Second Line Business Practice Location Address:
KALIHI-PALAMA HEALTH CENTER
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-845-8578
Provider Business Practice Location Address Fax Number:
808-845-7279
Provider Enumeration Date:
06/15/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VF0040X , with the licence number:  18243 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)