Provider Demographics
NPI:1477179901
Name:AZAMA, LENA (NDTR)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:AZAMA
Suffix:
Gender:F
Credentials:NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-820 LUMIAUAU ST APT E201
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-6802
Mailing Address - Country:US
Mailing Address - Phone:207-318-1422
Mailing Address - Fax:
Practice Address - Street 1:94-820 LUMIAUAU ST APT E201
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-6802
Practice Address - Country:US
Practice Address - Phone:207-318-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI86174403136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered