Healthcare Provider Details

I. General information

NPI: 1245253665
Provider Name (Legal Business Name): DORIS YAMANOHA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DORIS GOYA

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 ULULANI ST
HILO HI
96720-3913
US

IV. Provider business mailing address

71 ALOHALANI DR
HILO HI
96720-5550
US

V. Phone/Fax

Practice location:
  • Phone: 808-934-9400
  • Fax: 808-934-0232
Mailing address:
  • Phone: 808-959-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number473767
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: