Healthcare Provider Details

I. General information

NPI: 1487632410
Provider Name (Legal Business Name): MERNAL FUMI MIYASATO-CRAWFORD LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD SOCIAL WORK DEPT.
TAMC HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD SOCIAL WORK DEPT.
TAMC HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-2771
  • Fax: 808-433-1557
Mailing address:
  • Phone: 808-433-2771
  • Fax: 808-433-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW-152
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: