Healthcare Provider Details

I. General information

NPI: 1235921610
Provider Name (Legal Business Name): MISS RAISSA LOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 DOLE ST
HONOLULU HI
96822-2309
US

IV. Provider business mailing address

3325 MAUNALOA AVE APT A1
HONOLULU HI
96816-2182
US

V. Phone/Fax

Practice location:
  • Phone: 808-956-9559
  • Fax:
Mailing address:
  • Phone: 585-748-1788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: