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General NPI Number Information
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NPI Number | 1891130852
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Entity Type | Individual
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Provider Name | ELNUR GAJIEV PSYD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 28-1672 OLD MAMALAHOA HWY BACK BUILDING, 2ND FLOOR
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City | HONOMU
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State | HI
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Zip | 96728
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Country | US
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Telephone | 347-602-2596
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 831153
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City | PEPEEKEO
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State | HI
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Zip | 96783-1072
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Country | US
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Telephone | 347-602-2596
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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 | 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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