Healthcare Provider Details

I. General information

NPI: 1952220634
Provider Name (Legal Business Name): ELLIANA RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 LOWER CAMPUS RD
HONOLULU HI
96822-2352
US

IV. Provider business mailing address

1833 KALIHI ST
HONOLULU HI
96819-4249
US

V. Phone/Fax

Practice location:
  • Phone: 808-956-6178
  • Fax:
Mailing address:
  • Phone: 805-264-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: