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General NPI Number Information
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NPI Number | 1538740766
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Entity Type | Organization
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Legal Business Name | LIFESTYLE MEDICINE CENTER OF HAWAII, LLC
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 75-1027 HENRY ST STE 110
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City | KAILUA KONA
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State | HI
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Zip | 96740-3154
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Country | US
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Telephone | 808-769-5225
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Fax | 808-769-5099
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Provider Business Mailing Address
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Address Line | 75-1027 HENRY ST STE 110
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City | KAILUA KONA
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State | HI
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Zip | 96740-3154
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Country | US
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Telephone | 808-769-5225
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Fax | 808-769-5099
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Authorized Official
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Title or Position | DIRECTOR
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Name | APRIL M JOHNSON
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Credential |
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Telephone | 808-854-1162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC3500X
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Taxonomy Name | Cardiac Rehabilitation Registered Nurse
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License Number |
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License Number State |
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