Healthcare Provider Details

I. General information

NPI: 1649382508
Provider Name (Legal Business Name): NA PU UWAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 MAUNALOA HIGHWAY, BLDG. C
KAUNAKAKAI HI
96748-0130
US

IV. Provider business mailing address

PO BOX 130 604 MAUNALOA HIGHWAY, BLDG. C
KAUNAKAKAI HI
96748-0130
US

V. Phone/Fax

Practice location:
  • Phone: 808-560-3653
  • Fax: 808-560-3385
Mailing address:
  • Phone: 808-560-3653
  • Fax: 808-560-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JERRY J CLEMENTE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 808-560-3656