Healthcare Provider Details

I. General information

NPI: 1962338376
Provider Name (Legal Business Name): JAZZLYNN-GRACE KAWAILIULA PASCUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 ONOHI LN
KALAHEO HI
96741-9221
US

IV. Provider business mailing address

PO BOX 662265
LIHUE HI
96766-7265
US

V. Phone/Fax

Practice location:
  • Phone: 808-346-6421
  • Fax:
Mailing address:
  • Phone: 808-346-6421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberH01178728
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: