Healthcare Provider Details

I. General information

NPI: 1184396467
Provider Name (Legal Business Name): PASSI IAFETA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2176 LAUWILIWILI ST STE 1
KAPOLEI HI
96707-1882
US

IV. Provider business mailing address

91-1135 KAMAAHA LOOP # 16C
KAPOLEI HI
96707-2919
US

V. Phone/Fax

Practice location:
  • Phone: 808-272-5355
  • Fax: 808-200-4955
Mailing address:
  • Phone: 808-542-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-1218
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: