Healthcare Provider Details

I. General information

NPI: 1669972030
Provider Name (Legal Business Name): KEALOHAKUUALOHAKUUPO BALAZ DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 LILIHA ST UNIT 104
HONOLULU HI
96817-1646
US

IV. Provider business mailing address

98-1901 KAAHUMANU ST APT F
AIEA HI
96701-1850
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-4476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2397
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: