Healthcare Provider Details

I. General information

NPI: 1720795032
Provider Name (Legal Business Name): LENA MAHEALANI TUILOMA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-450 MOKUOLA ST
WAIPAHU HI
96797-3388
US

IV. Provider business mailing address

89-539 ULEI LOOP
WAIANAE HI
96792-3895
US

V. Phone/Fax

Practice location:
  • Phone: 808-944-2882
  • Fax:
Mailing address:
  • Phone: 808-520-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-911
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-165441
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: