Provider Demographics
NPI:1396173001
Name:RAJALA, KRISTIN (MA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:RAJALA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 WAIANUENUE AVENUE
Mailing Address - Street 2:HILO MEDICAL CENTER - ATTN: CLINIC ADMINISTRATION
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2020
Mailing Address - Country:US
Mailing Address - Phone:808-932-3428
Mailing Address - Fax:808-974-6723
Practice Address - Street 1:45 MOHOULI STREET, STE #101
Practice Address - Street 2:HILO MEDICAL CENTER -HAWAII ISLAND FAMILY HEALTH CENTER
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-932-4215
Practice Address - Fax:808-933-9291
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI1574103TC0700X
NE10094103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical