Provider Demographics
NPI:1750793246
Name:HERMOSURA, ANDREA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:HERMOSURA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:NACAPOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:677 ALA MOANA BLVD STE 1001
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5408
Mailing Address - Country:US
Mailing Address - Phone:808-692-1059
Mailing Address - Fax:
Practice Address - Street 1:677 ALA MOANA BLVD
Practice Address - Street 2:STE 1016
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5419
Practice Address - Country:US
Practice Address - Phone:808-469-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1581103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service