Healthcare Provider Details

I. General information

NPI: 1043760077
Provider Name (Legal Business Name): OHANA WELLNESS MAUI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S WAKEA AVE SUITE 105
KAHULUI HI
96732-1385
US

IV. Provider business mailing address

PO BOX 1710
KAHULUI HI
96733-1710
US

V. Phone/Fax

Practice location:
  • Phone: 808-281-1902
  • Fax:
Mailing address:
  • Phone: 808-281-1902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number493
License Number StateHI

VIII. Authorized Official

Name: YVONNE MANUPUNA
Title or Position: FAMILY THERAPIST
Credential: LMFT
Phone: 808-281-1901