Healthcare Provider Details

I. General information

NPI: 1750793246
Provider Name (Legal Business Name): ANDREA HERMOSURA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA NACAPOY

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 ALA MOANA BLVD STE 1016
HONOLULU HI
96813-5419
US

IV. Provider business mailing address

677 ALA MOANA BLVD STE 1001
HONOLULU HI
96813-5408
US

V. Phone/Fax

Practice location:
  • Phone: 808-469-4383
  • Fax:
Mailing address:
  • Phone: 808-692-1059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY1581
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: