Provider Demographics
NPI:1770019390
Name:NONTANI, MEGUMI
Entity Type:Individual
Prefix:
First Name:MEGUMI
Middle Name:
Last Name:NONTANI
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 1:710 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2119
Mailing Address - Country:US
Mailing Address - Phone:808-536-1015
Mailing Address - Fax:808-524-8186
Practice Address - Street 1:200 N VINEYARD BLVD
Practice Address - Street 2:SUITE 153
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3950
Practice Address - Country:US
Practice Address - Phone:808-523-8188
Practice Address - Fax:808-524-8186
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA-309103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst