Healthcare Provider Details

I. General information

NPI: 1215875943
Provider Name (Legal Business Name): DESTINY-JADE KIMIKO ROBERTS-WADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 N NIMITZ HWY RM C210
HONOLULU HI
96817-6514
US

IV. Provider business mailing address

1130 N NIMITZ HWY RM C210
HONOLULU HI
96817-6514
US

V. Phone/Fax

Practice location:
  • Phone: 808-838-7752
  • Fax:
Mailing address:
  • Phone: 808-838-7752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: