Healthcare Provider Details

I. General information

NPI: 1093842171
Provider Name (Legal Business Name): REYNOLD MASAJI GIMA MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 LANAI AVE., #113
LANAI CITY HI
96763-0086
US

IV. Provider business mailing address

PO BOX 630086
LANAI CITY HI
96763-0086
US

V. Phone/Fax

Practice location:
  • Phone: 808-565-6189
  • Fax: 808-565-7426
Mailing address:
  • Phone: 808-565-6189
  • Fax: 808-565-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: