Provider Demographics
NPI:1245265412
Name:FUJIOKA, TERRY ANN T (PHD)
Entity type:Individual
Prefix:
First Name:TERRY ANN
Middle Name:T
Last Name:FUJIOKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79-7460 MAMALAHOA HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-7917
Mailing Address - Country:US
Mailing Address - Phone:808-324-0434
Mailing Address - Fax:808-324-0129
Practice Address - Street 1:79-7460 MAMALAHOA HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7917
Practice Address - Country:US
Practice Address - Phone:808-324-0434
Practice Address - Fax:808-324-0129
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0092807OtherHMSA
HI071367Medicaid
HI071367Medicaid