Provider Demographics
NPI:1477049336
Name:LETULI, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:LETULI
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:HC 3 BOX 14031
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-9214
Mailing Address - Country:US
Mailing Address - Phone:808-640-3431
Mailing Address - Fax:
Practice Address - Street 1:74-5078 KUMAKANI ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1530
Practice Address - Country:US
Practice Address - Phone:808-640-3431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician