Healthcare Provider Details

I. General information

NPI: 1104101252
Provider Name (Legal Business Name): WALTER K HOOPAI MAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MAHALANI ST SUITE 21
WAILUKU HI
96793-2521
US

IV. Provider business mailing address

95 MAHALANI ST SUITE 21
WAILUKU HI
96793-2521
US

V. Phone/Fax

Practice location:
  • Phone: 808-442-6856
  • Fax: 808-249-0107
Mailing address:
  • Phone: 808-442-6856
  • Fax: 808-249-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMAT-12203
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: