Healthcare Provider Details

I. General information

NPI: 1871633008
Provider Name (Legal Business Name): MONA H IWATANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 CALIFORNIA AVE
WAHIAWA HI
96786-2124
US

IV. Provider business mailing address

1700 LANAKILA AVE
HONOLULU HI
96817-2115
US

V. Phone/Fax

Practice location:
  • Phone: 808-621-8425
  • Fax: 808-622-5189
Mailing address:
  • Phone: 808-832-3823
  • Fax: 808-832-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: