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General NPI Number Information
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NPI Number | 1164897443
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Entity Type | Organization
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Legal Business Name | IMI OLA
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Dates
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Enumeration Date | 12/11/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 290 KOLAPA PL
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City | KAUNAKAKAI
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State | HI
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Zip | 96748-4030
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Country | US
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Telephone | 808-646-1497
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1071
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City | KAUNAKAKAI
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State | HI
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Zip | 96748-1071
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Country | US
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Telephone | 808-646-1497
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. MICHAEL NAPOLI
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Credential |
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Telephone | 808-646-1440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY1271
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License Number State | HI
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