1063820009 NPI number — HAWAII MOTHERS' MILK, INC.

Table of content: VIRGINIA THOMAS RD, CDE (NPI 1407085566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063820009 NPI number — HAWAII MOTHERS' MILK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWAII MOTHERS' MILK, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063820009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1319 PUNAHOU ST
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:
96826-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-947-6920
Provider Business Mailing Address Fax Number:
808-441-9922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1319 PUNAHOU ST
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:
96826-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-947-6920
Provider Business Practice Location Address Fax Number:
808-441-9922
Provider Enumeration Date:
07/22/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANE
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
808-947-6920

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 40404586 - 01 , 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)