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General NPI Number Information
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NPI Number | 1184281818
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Entity Type | Organization
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Legal Business Name | MAULIHIWA WELLNESS, LLC
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 46-005 KAWA ST STE 203
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City | KANEOHE
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State | HI
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Zip | 96744-3812
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Country | US
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Telephone | 808-247-9616
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Fax |
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Provider Business Mailing Address
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Address Line | 45-468 C-1 KAMEHAMEHA HWY
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City | KANEOHE
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State | HI
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Zip | 96744
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Country | US
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Telephone | 808-227-5696
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAHELAHO'OPOMAIKA'I BLAKE
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Credential | APRN-RX
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Telephone | 808-247-9616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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