Healthcare Provider Details

I. General information

NPI: 1629379052
Provider Name (Legal Business Name): ZAHAVA ZAIDOFF CSAC, M-RAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82-996 ANOI PL
CAPTAIN COOK HI
96704-8239
US

IV. Provider business mailing address

PO BOX 1035
KAILUA KONA HI
96745-1035
US

V. Phone/Fax

Practice location:
  • Phone: 808-626-5054
  • Fax:
Mailing address:
  • Phone: 760-317-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: