Provider Demographics
NPI:1205201431
Name:MAMHOT, VANESSA ALFOJA (NC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ALFOJA
Last Name:MAMHOT
Suffix:
Gender:F
Credentials:NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-927 PAIKAUHALE ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2847
Mailing Address - Country:US
Mailing Address - Phone:360-969-1875
Mailing Address - Fax:
Practice Address - Street 1:210 WARD AVE STE 219B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4003
Practice Address - Country:US
Practice Address - Phone:808-585-1424
Practice Address - Fax:808-585-0379
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst