Healthcare Provider Details

I. General information

NPI: 1396552576
Provider Name (Legal Business Name): MONELIZ VITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONA N/A N/A

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 PAA ST
HONOLULU HI
96819-4430
US

IV. Provider business mailing address

2828 PAA ST
HONOLULU HI
96819-4430
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-4660
  • Fax:
Mailing address:
  • Phone: 808-432-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-627-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: