Healthcare Provider Details

I. General information

NPI: 1144301383
Provider Name (Legal Business Name): BLUE WATER RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-229 WAIPAHU DEPOT ROAD SUITE 401
WAIPAHU HI
96797-3031
US

IV. Provider business mailing address

94-229 WAIPAHU DEPOT ROAD SUITE 401
WAIPAHU HI
96797-3031
US

V. Phone/Fax

Practice location:
  • Phone: 808-678-3661
  • Fax: 808-678-3662
Mailing address:
  • Phone: 808-678-3661
  • Fax: 808-678-3662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateHI

VIII. Authorized Official

Name: MRS. SARAH SUZUKI
Title or Position: CO-OWNER
Credential: R.N., B.S.N., M.B.A
Phone: 808-678-3661