MEDICARE: REYNOLD MASAJI GIMA MSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1093842171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNOLD MASAJI GIMA MSC

Provider Business Mailing Address
First Line	:	PO BOX 630086
Second Line	:
City	:	LANAI CITY
State	:	HI
Zip	:	96763-0086
Country	:	US
Telephone Number	:	808-565-6189
Fax Number	:	808-565-7426

Provider Business Practice Location Address
First Line	:	730 LANAI AVE., #113
Second Line	:
City	:	LANAI CITY
State	:	HI
Zip	:	96763-0086
Country	:	US
Telephone Number	:	808-565-6189
Fax Number	:	808-565-7426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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