Provider Demographics
NPI:1114150281
Name:MAMALIAS, KATHY Y (CHS)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:Y
Last Name:MAMALIAS
Suffix:
Gender:F
Credentials:CHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 ANAPANAPA ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1133
Mailing Address - Country:US
Mailing Address - Phone:808-216-9694
Mailing Address - Fax:808-455-6052
Practice Address - Street 1:2306 ANAPANAPA ST
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-1133
Practice Address - Country:US
Practice Address - Phone:808-216-9694
Practice Address - Fax:808-455-6052
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist