Provider Demographics
NPI:1639716483
Name:MITSUNAGA, LEILA TOMOYO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:TOMOYO
Last Name:MITSUNAGA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-1295 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795-1536
Mailing Address - Country:US
Mailing Address - Phone:808-259-7948
Mailing Address - Fax:808-259-7447
Practice Address - Street 1:41-1295 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1536
Practice Address - Country:US
Practice Address - Phone:808-259-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1821103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist