Provider Demographics
NPI:1093842171
Name:GIMA, REYNOLD MASAJI (MSC)
Entity Type:Individual
Prefix:
First Name:REYNOLD
Middle Name:MASAJI
Last Name:GIMA
Suffix:
Gender:M
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 630086
Mailing Address - Street 2:
Mailing Address - City:LANAI CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96763-0086
Mailing Address - Country:US
Mailing Address - Phone:808-565-6189
Mailing Address - Fax:808-565-7426
Practice Address - Street 1:730 LANAI AVE., #113
Practice Address - Street 2:
Practice Address - City:LANAI CITY
Practice Address - State:HI
Practice Address - Zip Code:96763-0086
Practice Address - Country:US
Practice Address - Phone:808-565-6189
Practice Address - Fax:808-565-7426
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker