Healthcare Provider Details

I. General information

NPI: 1619886033
Provider Name (Legal Business Name): MRS. ANGELA K GOMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5463 MAMALAHOA HWY
HOLUALOA HI
96725
US

IV. Provider business mailing address

75-5463 MAMALAHOA HWY
HOLUALOA HI
96725
US

V. Phone/Fax

Practice location:
  • Phone: 808-300-6085
  • Fax:
Mailing address:
  • Phone: 808-443-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberH1000019617E
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: