Healthcare Provider Details

I. General information

NPI: 1720697170
Provider Name (Legal Business Name): HAWAII HOLISTIC HEALTH NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 AEWA PL SUITE 12
PUKALANI HI
96768
US

IV. Provider business mailing address

25 KUINEHE PL
MAKAWAO HI
96768-8285
US

V. Phone/Fax

Practice location:
  • Phone: 808-359-3336
  • Fax: 808-572-0394
Mailing address:
  • Phone: 719-439-7022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: OMAYRA G ROCCO
Title or Position: OWNER
Credential:
Phone: 808-359-3336