Healthcare Provider Details

I. General information

NPI: 1831345149
Provider Name (Legal Business Name): ISIDRO PAUL HERMOSURA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SID PAUL HERMOSURA PSY.D.

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41-1347 KALANIANAOLE HWY
WAIMANALO HI
96795-1247
US

IV. Provider business mailing address

41-1347 KALANIANAOLE HWY
WAIMANALO HI
96795-1297
US

V. Phone/Fax

Practice location:
  • Phone: 808-259-7948
  • Fax:
Mailing address:
  • Phone: 808-259-7948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1280
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: