Healthcare Provider Details

I. General information

NPI: 1164086336
Provider Name (Legal Business Name): ALLAN JAMES ABLAZA SAOIT APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 KUALA ST STE 102A
PEARL CITY HI
96782-3900
US

IV. Provider business mailing address

460 KAMAAHA AVE APT 32
KAPOLEI HI
96707-4617
US

V. Phone/Fax

Practice location:
  • Phone: 808-627-2775
  • Fax:
Mailing address:
  • Phone: 808-627-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number87570
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5296
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: