Healthcare Provider Details

I. General information

NPI: 1851178099
Provider Name (Legal Business Name): SELA TUPOU PASI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 660 KAMEHAMEHA HWY
KAHUKU HI
96731
US

IV. Provider business mailing address

55 660 KAMEHAMEHA HWY
KAHUKU HI
96731
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-7555
  • Fax: 808-293-7196
Mailing address:
  • Phone: 808-293-7555
  • Fax: 808-293-7196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number53-STF
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: