Healthcare Provider Details

I. General information

NPI: 1992425763
Provider Name (Legal Business Name): CHRISTINA MALIA METHOD REQUELMAN CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E PUAINAKO ST
HILO HI
96720-5243
US

IV. Provider business mailing address

50 E PUAINAKO ST
HILO HI
96720-5294
US

V. Phone/Fax

Practice location:
  • Phone: 808-959-8700
  • Fax:
Mailing address:
  • Phone: 808-959-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number410101070951424
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: