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General NPI Number Information
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NPI Number | 1407404387
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Entity Type | Individual
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Provider Name | LYRA FUMIKO RONQUILLO CHUA
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Gender | Female
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 55 MAUI LANI PKWY
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City | WAILUKU
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State | HI
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Zip | 96793-2416
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Country | US
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Telephone | 808-243-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 4955 HANAWAI ST APT 9-104
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City | LAHAINA
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State | HI
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Zip | 96761-8818
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Country | US
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Telephone | 707-386-2843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2736
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License Number State | HI
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