Healthcare Provider Details

I. General information

NPI: 1063800662
Provider Name (Legal Business Name): RUMI ISOGAI BUMBERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 KAALA ST
HONOLULU HI
96822-2204
US

IV. Provider business mailing address

800 S BERETANIA ST SUITE 100
HONOLULU HI
96813-5703
US

V. Phone/Fax

Practice location:
  • Phone: 808-973-5095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN - 78472
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT 135
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004344
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: