Healthcare Provider Details

I. General information

NPI: 1851084057
Provider Name (Legal Business Name): HOALA I KE OLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S BERETANIA ST
HONOLULU HI
96813-2501
US

IV. Provider business mailing address

PO BOX 1540
HONOLULU HI
96806-1540
US

V. Phone/Fax

Practice location:
  • Phone: 808-753-3935
  • Fax:
Mailing address:
  • Phone: 808-753-3935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBIN WENTZEL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 808-753-3965