Provider Demographics
NPI:1326563768
Name:MATSUOKA, KOALAANUHEAMAIKALANI
Entity Type:Individual
Prefix:
First Name:KOALAANUHEAMAIKALANI
Middle Name:
Last Name:MATSUOKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 HOOKAHI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1466
Mailing Address - Country:US
Mailing Address - Phone:808-244-2330
Mailing Address - Fax:
Practice Address - Street 1:270 HOOKAHI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1466
Practice Address - Country:US
Practice Address - Phone:808-244-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist