Provider Demographics
NPI:1629883202
Name:NITAHARA, ROY KAIKALANI JR
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:KAIKALANI
Last Name:NITAHARA
Suffix:JR
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 1:91-1005 KANIO ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3222
Mailing Address - Country:US
Mailing Address - Phone:808-913-8774
Mailing Address - Fax:
Practice Address - Street 1:91-1005 KANIO ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3222
Practice Address - Country:US
Practice Address - Phone:808-913-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1168740106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician