Provider Demographics
NPI:1083067565
Name:ANDUHA, MIA (BA)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:ANDUHA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 SALT LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3153
Mailing Address - Country:US
Mailing Address - Phone:808-861-6141
Mailing Address - Fax:
Practice Address - Street 1:94-333 HOKUAHIAHI ST APT 402
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1912
Practice Address - Country:US
Practice Address - Phone:808-861-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst