Provider Demographics
NPI:1932139102
Name:ROSE, TOMAO LUU (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:TOMAO
Middle Name:LUU
Last Name:ROSE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1079 MOANALUA RD STE 620
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4716
Mailing Address - Country:US
Mailing Address - Phone:808-486-7775
Mailing Address - Fax:
Practice Address - Street 1:98-1079 MOANALUA RD STE 620
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4716
Practice Address - Country:US
Practice Address - Phone:808-486-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD757363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant