Provider Demographics
NPI:1366795635
Name:WESTGATE MEDICAL CENTER
Entity type:Organization
Organization Name:WESTGATE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LULUMAFUIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIATOA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-589-2259
Mailing Address - Street 1:94-370 PUPUPANI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2657
Mailing Address - Country:US
Mailing Address - Phone:888-589-2259
Mailing Address - Fax:
Practice Address - Street 1:94-370 PUPUPANI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2657
Practice Address - Country:US
Practice Address - Phone:888-589-2259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD5016208000000X, 207Q00000X
HI14877208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01723602Medicaid