Healthcare Provider Details

I. General information

NPI: 1689980021
Provider Name (Legal Business Name): RIE LEILANI KUHAULUA M.A., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 QUINAN ST
PINOLE CA
94564-1621
US

IV. Provider business mailing address

1132 3RD ST
RODEO CA
94572-1307
US

V. Phone/Fax

Practice location:
  • Phone: 510-741-7286
  • Fax:
Mailing address:
  • Phone: 510-545-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: