Provider Demographics
NPI:1891553319
Name:OMANA, ELAINA DAE (MAT)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:DAE
Last Name:OMANA
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:DAE
Other - Last Name:BEREITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4-971 KUHIO HWY STE 109
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1553
Mailing Address - Country:US
Mailing Address - Phone:808-821-1100
Mailing Address - Fax:
Practice Address - Street 1:4-971 KUHIO HWY STE 109
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1553
Practice Address - Country:US
Practice Address - Phone:808-821-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist