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General NPI Number Information
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NPI Number | 1033882105
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Entity Type | Organization
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Legal Business Name | OPTIMUM HEALTH AND WELLNESS HAWAII
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 74 KIHAPAI ST
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City | KAILUA
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State | HI
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Zip | 96734-2612
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Country | US
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Telephone | 808-490-3250
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Fax |
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Provider Business Mailing Address
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Address Line | 74 KIHAPAI ST
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City | KAILUA
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State | HI
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Zip | 96734-2612
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Country | US
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Telephone | 808-490-3250
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE BOLING
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Credential | MPH, MSN, APRN-RX
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Telephone | 808-490-3250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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