Healthcare Provider Details

I. General information

NPI: 1326607391
Provider Name (Legal Business Name): CRYSTAL THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL ROMERO

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-820 MOANALUA RD SPC 5
AIEA HI
96701-5200
US

IV. Provider business mailing address

21 LOPAKA PL
KULA HI
96790-8514
US

V. Phone/Fax

Practice location:
  • Phone: 808-845-6080
  • Fax:
Mailing address:
  • Phone: 808-205-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-827
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: