Healthcare Provider Details

I. General information

NPI: 1942396379
Provider Name (Legal Business Name): HOLO MUA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 ALALUANA RD
MAKAWAO HI
96768-7202
US

IV. Provider business mailing address

PO BOX 4010
KAHULUI HI
96733-4010
US

V. Phone/Fax

Practice location:
  • Phone: 808-572-4770
  • Fax:
Mailing address:
  • Phone: 808-572-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number973
License Number StateHI

VIII. Authorized Official

Name: MR. JEWAN JERNAILL
Title or Position: CO-MANAGER
Credential:
Phone: 808-572-4770