Healthcare Provider Details

I. General information

NPI: 1134133713
Provider Name (Legal Business Name): HUI MALAMA OLA NA 'OIWI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 KILAUEA AVE
HILO HI
96720-4286
US

IV. Provider business mailing address

1438 KILAUEA AVE
HILO HI
96720-4286
US

V. Phone/Fax

Practice location:
  • Phone: 808-969-9220
  • Fax: 808-961-4794
Mailing address:
  • Phone: 808-969-9220
  • Fax: 808-961-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADINA ALLAN FRONIUS
Title or Position: CREDENTIALLING CONTROLLER
Credential:
Phone: 951-265-1292