Healthcare Provider Details

I. General information

NPI: 1295618205
Provider Name (Legal Business Name): EREONG AMANDA YALAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 KILAUEA AVE STE A
HILO HI
96720-4291
US

IV. Provider business mailing address

1045 KILAUEA AVE STE A
HILO HI
96720-4291
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-2188
  • Fax:
Mailing address:
  • Phone: 808-313-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: