Provider Demographics
NPI:1528222395
Name:UNIVERSITY OF HAWAII AT MANOA
Entity Type:Organization
Organization Name:UNIVERSITY OF HAWAII AT MANOA
Other - Org Name:UH MAUI COLLEGE CAMPUS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-984-3493
Mailing Address - Street 1:1601 E WEST RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96848-1601
Mailing Address - Country:US
Mailing Address - Phone:808-984-3493
Mailing Address - Fax:808-242-1578
Practice Address - Street 1:310 W KAAHUMANU AVE # 202
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1643
Practice Address - Country:US
Practice Address - Phone:808-984-3493
Practice Address - Fax:808-242-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN - 183261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDF892AOtherPTAN
HI=========OtherEIN