Healthcare Provider Details

I. General information

NPI: 1619588415
Provider Name (Legal Business Name): TARA COMPEHOS LM, LMT, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 04/30/2024
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-2166 SOUTH POINT RD.
NAALEHU HI
96772
US

IV. Provider business mailing address

PO BOX 635
PAHALA HI
96777-0635
US

V. Phone/Fax

Practice location:
  • Phone: 808-450-0498
  • Fax:
Mailing address:
  • Phone: 808-450-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberMW-23
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number333827
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6081
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: