Basic Information
| Provider Information | |||||||||
| NPI: | 1003357765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WARFIGHTER'S CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91-1027 SHANGRILA ST | ||||||||
| Address2: | BLDG 1867 | ||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967072101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083456832 | ||||||||
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| Practice Location | |||||||||
| Address1: | 91-1027 SHANGRILA ST | ||||||||
| Address2: | BLDG 1867 | ||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967072101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083456832 | ||||||||
| FaxNumber: | 8086749696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2017 | ||||||||
| LastUpdateDate: | 03/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | ANEGAWA | ||||||||
| AuthorizedOfficialFirstName: | NORIFUSA | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8083456832 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204R00000X | MD 13015 | HI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Electrodiagnostic Medicine | 2251X0800X | PT 1815 | HI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 208VP0000X | MD 13015 | HI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.