12D0944192 CLIA NUMBER - RUSSELL G TACATA MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 12D0944192
  • Facility Name: RUSSELL G TACATA MEDICAL CLINIC
  • Facility Address: 1619 LILIHA ST STE #3
    HONOLULU, HI
    ZIP 96817
  • Facility Phone: 808 531-5454
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUSSELL G. TACATA
  • NPI Number: 1356341002
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 12D0944192
LAB Type Physician Office
Facility Name RUSSELL G TACATA MEDICAL CLINIC
Street 1619 LILIHA ST STE #3
City HONOLULU
State HI
ZIP 96817
Phone 808 531-5454
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2024
Certificate Expiration Date 4/7/2026
Facility Type Physician Office
Lab Director RUSSELL G. TACATA

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This page was last updated on: 9/29/2025