Provider Demographics
NPI:1972965408
Name:TAITANO, GENIA CZECHOWICZ
Entity type:Individual
Prefix:
First Name:GENIA
Middle Name:CZECHOWICZ
Last Name:TAITANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78-6831 ALII DR STE 422
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-5402
Mailing Address - Country:US
Mailing Address - Phone:808-909-3883
Mailing Address - Fax:808-323-2119
Practice Address - Street 1:78-6831 ALII DR STE 422
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-5402
Practice Address - Country:US
Practice Address - Phone:808-909-3206
Practice Address - Fax:808-323-2119
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HIMD-23416-0208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program