Healthcare Provider Details

I. General information

NPI: 1366374191
Provider Name (Legal Business Name): IRIS WATANABE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 WAIALAE AVE
HONOLULU HI
96816-1578
US

IV. Provider business mailing address

943 19TH AVE
HONOLULU HI
96816-4604
US

V. Phone/Fax

Practice location:
  • Phone: 808-735-4711
  • Fax:
Mailing address:
  • Phone: 808-735-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN-81134
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: