Healthcare Provider Details

I. General information

NPI: 1518238963
Provider Name (Legal Business Name): THOMAS H MIYASHIRO MSCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S BERETANIA ST
HONOLULU HI
96814-1428
US

IV. Provider business mailing address

2054 HOOHAI ST
PEARL CITY HI
96782-1423
US

V. Phone/Fax

Practice location:
  • Phone: 808-545-2740
  • Fax: 808-545-2852
Mailing address:
  • Phone: 808-383-7494
  • Fax: 808-545-2852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number421
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: