Provider Demographics
NPI:1497256051
Name:MOORE, AVIELLA KNOVELRHEA
Entity Type:Individual
Prefix:MS
First Name:AVIELLA
Middle Name:KNOVELRHEA
Last Name:MOORE
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 1:1215 S KIHEI RD
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5220
Mailing Address - Country:US
Mailing Address - Phone:808-357-3504
Mailing Address - Fax:
Practice Address - Street 1:2439 S KIHEI RD
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7283
Practice Address - Country:US
Practice Address - Phone:808-357-3504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBEO21072224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist