Healthcare Provider Details

I. General information

NPI: 1720029606
Provider Name (Legal Business Name): PUNA KAMALII FLOWERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16-211 KALARA ST
KEAAU HI
96749-8005
US

IV. Provider business mailing address

16-211 KALARA ST
KEAAU HI
96749-8005
US

V. Phone/Fax

Practice location:
  • Phone: 808-982-8322
  • Fax: 808-982-8544
Mailing address:
  • Phone: 808-982-8322
  • Fax: 808-982-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateHI

VIII. Authorized Official

Name: MRS. VICKI L NELSON
Title or Position: PRESIDENT
Credential:
Phone: 808-982-8322