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General NPI Number Information
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NPI Number | 1073290623
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Entity Type | Organization
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Legal Business Name | HUI MALAMA LEGACY FOUNDATION
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 84-670 UPENA ST
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City | WAIANAE
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State | HI
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Zip | 96792-1934
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Country | US
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Telephone | 808-868-7172
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Fax |
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Provider Business Mailing Address
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Address Line | 84-670 UPENA ST
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City | WAIANAE
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State | HI
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Zip | 96792-1934
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Country | US
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Telephone | 808-868-7172
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SADE SOARES
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Credential | PSYCHOLOGIST
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Telephone | 808-868-7172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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