Healthcare Provider Details

I. General information

NPI: 1235859539
Provider Name (Legal Business Name): ROCHELLE COLOMA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-211 PALI MOMI ST STE 312
AIEA HI
96701-4306
US

IV. Provider business mailing address

98-211 PALI MOMI ST STE 312
AIEA HI
96701-4306
US

V. Phone/Fax

Practice location:
  • Phone: 808-486-0449
  • Fax: 808-488-0725
Mailing address:
  • Phone: 808-486-0449
  • Fax: 808-488-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-1372
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: