Provider Demographics
NPI:1417006081
Name:FRAZIER, LA-TISHA (MD)
Entity type:Individual
Prefix:DR
First Name:LA-TISHA
Middle Name:
Last Name:FRAZIER
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 1:1319 PUNAHOU ST STE 824
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1032
Mailing Address - Country:US
Mailing Address - Phone:808-203-6532
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST STE 824
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1032
Practice Address - Country:US
Practice Address - Phone:808-203-6532
Practice Address - Fax:808-955-2174
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4353P363LA2200X
390200000X
KY3004353363L00000X
HIMD-24448207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK172300Medicare PIN