Provider Demographics
NPI:1275273641
Name:FUJIMOTO, MICHAEL MITSUO
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MITSUO
Last Name:FUJIMOTO
Suffix:
Gender:M
Credentials:
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 22005
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-2005
Mailing Address - Country:US
Mailing Address - Phone:808-780-0014
Mailing Address - Fax:
Practice Address - Street 1:710 PALEKAUA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-4755
Practice Address - Country:US
Practice Address - Phone:808-780-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-21-180570106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician