Healthcare Provider Details

I. General information

NPI: 1396173001
Provider Name (Legal Business Name): KRISTIN RAJALA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MOHOULI STREET, STE #101 HILO MEDICAL CENTER -HAWAII ISLAND FAMILY HEALTH CENTER
HILO HI
96720
US

IV. Provider business mailing address

1190 WAIANUENUE AVENUE HILO MEDICAL CENTER - ATTN: CLINIC ADMINISTRATION
HILO HI
96720-2020
US

V. Phone/Fax

Practice location:
  • Phone: 808-932-4215
  • Fax: 808-933-9291
Mailing address:
  • Phone: 808-932-3428
  • Fax: 808-974-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1574
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number10094
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: