Healthcare Provider Details

I. General information

NPI: 1790902120
Provider Name (Legal Business Name): HALE MAKUA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 KAULANA ST
KAHULUI HI
96732-2050
US

IV. Provider business mailing address

472 KAULANA ST
KAHULUI HI
96732-2050
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-2761
  • Fax: 808-871-9262
Mailing address:
  • Phone: 808-877-2761
  • Fax: 808-871-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateHI

VIII. Authorized Official

Name: WESLEY LO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 808-877-2761