Healthcare Provider Details

I. General information

NPI: 1376967802
Provider Name (Legal Business Name): HUA MOON WOMEN'S HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4-1558 KUHIO HWY
KAPAA HI
96746-1856
US

IV. Provider business mailing address

4-1558 KUHIO HWY
KAPAA HI
96746-1856
US

V. Phone/Fax

Practice location:
  • Phone: 808-639-9722
  • Fax: 866-423-3332
Mailing address:
  • Phone: 808-639-9722
  • Fax: 866-423-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number176B00000X
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number176B00000X
License Number StateHI

VIII. Authorized Official

Name: MRS. NICOLETTE GERMAINE AGUINALDO
Title or Position: OFFICE MANAGER
Credential:
Phone: 808-651-6341