Healthcare Provider Details

I. General information

NPI: 1790251833
Provider Name (Legal Business Name): MRS. BETTY J. HA'O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETTY J. GONSALVES

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85-888 FARRINGTON HWY
WAIANAE HI
96792-2403
US

IV. Provider business mailing address

86-226 FARRINGTON HWY
WAIANAE HI
96792-3128
US

V. Phone/Fax

Practice location:
  • Phone: 808-696-9498
  • Fax: 808-696-9403
Mailing address:
  • Phone: 808-696-4211
  • Fax: 808-696-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: