Healthcare Provider Details

I. General information

NPI: 1235610007
Provider Name (Legal Business Name): OHANA BREASTFEEDING AND NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 15TH AVE
HONOLULU HI
96816-3613
US

IV. Provider business mailing address

833 15TH AVE
HONOLULU HI
96816-3613
US

V. Phone/Fax

Practice location:
  • Phone: 808-561-3239
  • Fax:
Mailing address:
  • Phone: 808-561-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number180-LD
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-125869
License Number StateVA

VIII. Authorized Official

Name: MRS. MIHOKO MUNAKATA YACAVONE
Title or Position: OWNER
Credential: MS, RDN, IBCLC
Phone: 808-561-3239