Healthcare Provider Details

I. General information

NPI: 1952892689
Provider Name (Legal Business Name): MAYUMI COLOMA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 KILANI AVE STE 104
WAHIAWA HI
96786-2274
US

IV. Provider business mailing address

1034 KILANI AVE STE 104
WAHIAWA HI
96786-2274
US

V. Phone/Fax

Practice location:
  • Phone: 808-621-2322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-4246
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: