Healthcare Provider Details

I. General information

NPI: 1477460459
Provider Name (Legal Business Name): CRYSTAL EVANS GUTSOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 KINOOLE ST
HILO HI
96720-2918
US

IV. Provider business mailing address

PO BOX 11167
HILO HI
96721-6167
US

V. Phone/Fax

Practice location:
  • Phone: 808-664-4401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: