Healthcare Provider Details

I. General information

NPI: 1912244278
Provider Name (Legal Business Name): RACHEL RIPEKA LEILANI KEKAULA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-660 KAMEHAMEHA HWY
KAHUKU HI
96731-2210
US

IV. Provider business mailing address

56-455 PAHELEHALA LOOP PO BOX 723
KAHUKU HI
96731-2045
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-7555
  • Fax:
Mailing address:
  • Phone: 808-554-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2034
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: