Healthcare Provider Details

I. General information

NPI: 1841603651
Provider Name (Legal Business Name): CORINNE MAUL DE SOTO ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 07/03/2024
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5995 KUAKINI HWY STE 213
KAILUA KONA HI
96740-2120
US

IV. Provider business mailing address

75-5995 KUAKINI HWY STE 213
KAILUA KONA HI
96740-2120
US

V. Phone/Fax

Practice location:
  • Phone: 808-638-3343
  • Fax: 844-308-3545
Mailing address:
  • Phone: 808-638-3343
  • Fax: 844-308-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number258
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: