Basic Information
Provider Information
NPI: 1548446487
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PHILLIPS
FirstName: FATIMA
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: M.D., M.P.H., PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 224 HAILI ST
Address2: BLDG B
City: HILO
State: HI
PostalCode: 967202975
CountryCode: US
TelephoneNumber: 8089691427
FaxNumber:  
Practice Location
Address1: 1178 KINOOLE ST
Address2: BLDG B
City: HILO
State: HI
PostalCode: 967207206
CountryCode: US
TelephoneNumber: 8089691427
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/10/2008
LastUpdateDate: 08/31/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD-15428HIN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XME83731FLN Allopathic & Osteopathic PhysiciansFamily Medicine 
208D00000XMD-15428HIN Allopathic & Osteopathic PhysiciansGeneral Practice 
208D00000XME83731FLY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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