Provider Demographics
NPI:1306945803
Name:WAITE, JOSEPHINE DELA TORRE (MD)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:DELA TORRE
Last Name:WAITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 KILANI AVE
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2102
Mailing Address - Country:US
Mailing Address - Phone:808-621-5042
Mailing Address - Fax:808-621-9313
Practice Address - Street 1:916 KILANI AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2102
Practice Address - Country:US
Practice Address - Phone:808-621-5042
Practice Address - Fax:808-621-9313
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIG33816Medicare UPIN