1457290652 NPI number — ALEXIS ANASTASIA MIZE EINOLGHOZATI

Table of content: ALEXIS ANASTASIA MIZE EINOLGHOZATI (NPI 1457290652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457290652 NPI number — ALEXIS ANASTASIA MIZE EINOLGHOZATI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EINOLGHOZATI
Provider First Name:
ALEXIS
Provider Middle Name:
ANASTASIA MIZE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIZE
Provider Other First Name:
ALEXIS
Provider Other Middle Name:
ANASTASIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457290652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 638
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAIALUA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96791-0638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 638
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIALUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96791-0638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-712-5203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2026

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: 171100000X , with the licence number:  ACU-1483 , 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)





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