Healthcare Provider Details

I. General information

NPI: 1215845912
Provider Name (Legal Business Name): TRISHA HALEAKALA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CLARK DR
SAN MATEO CA
94402-1002
US

IV. Provider business mailing address

161 CLARK DR
SAN MATEO CA
94402-1002
US

V. Phone/Fax

Practice location:
  • Phone: 650-312-7577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: