Healthcare Provider Details

I. General information

NPI: 1053229617
Provider Name (Legal Business Name): KARISA KEALIINOHOMOKU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 MAKALOA ST STE 204-125
HONOLULU HI
96814-3232
US

IV. Provider business mailing address

94-269 NAPEHA PL
MILILANI HI
96789-2664
US

V. Phone/Fax

Practice location:
  • Phone: 877-504-4141
  • Fax:
Mailing address:
  • Phone: 808-319-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: