Healthcare Provider Details

I. General information

NPI: 1356598148
Provider Name (Legal Business Name): GLORIA ALOHIWAILANI ISHIBASHI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 WAIANUENUE AVE SUITE 215
HILO HI
96720-2418
US

IV. Provider business mailing address

691 AINAKO AVE
HILO HI
96720-1611
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-7949
  • Fax:
Mailing address:
  • Phone: 808-961-4417
  • 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: