1841418548 NPI number — LISA WAI MUI AMBROSINO HO PSY.D.

Table of content: LISA WAI MUI AMBROSINO HO PSY.D. (NPI 1841418548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841418548 NPI number — LISA WAI MUI AMBROSINO HO PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMBROSINO HO
Provider First Name:
LISA
Provider Middle Name:
WAI MUI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HO
Provider Other First Name:
LISA
Provider Other Middle Name:
WAI MUI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841418548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96828-1068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-356-9435
Provider Business Mailing Address Fax Number:
866-757-6564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1833 KALAKAUA AVE STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96815-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-356-9435
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY1512 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY25542 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY 1512 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)