Provider Demographics
NPI:1295130284
Name:FUKUSHIMA, RONALD JESSE KEAHI
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JESSE KEAHI
Last Name:FUKUSHIMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LEPELEPE PL
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-7608
Mailing Address - Country:US
Mailing Address - Phone:808-214-7408
Mailing Address - Fax:
Practice Address - Street 1:270 WAIEHU BEACH RD
Practice Address - Street 2:SUITE 110A
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1472
Practice Address - Country:US
Practice Address - Phone:808-242-7294
Practice Address - Fax:808-242-7296
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst