Healthcare Provider Details

I. General information

NPI: 1528257847
Provider Name (Legal Business Name): SIMONE KARLA CORREA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S KING ST #1516
HONOLULU HI
96814-1956
US

IV. Provider business mailing address

1833 ANAPUNI ST #103
HONOLULU HI
96822-3279
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-9339
  • Fax:
Mailing address:
  • Phone: 808-232-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMAT 8854
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: