=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912704966
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURRA HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2025
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51-162 KAMEHAMEHA HWY
-----------------------------------------------------
City | KAAAWA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-846-2147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1441 KAPIOLANI BLVD STE 1114 PMB 498732
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-846-2147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BENJAMIN LAUZIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-846-2147
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------