Provider Demographics
NPI:1811344864
Name:MURATA, ALYSSA (MD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MURATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:ATTEN: RHONELLE ACERET
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796-0669
Mailing Address - Country:US
Mailing Address - Phone:808-240-2723
Mailing Address - Fax:808-338-9420
Practice Address - Street 1:2469 PUU RD STE C
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8509
Practice Address - Country:US
Practice Address - Phone:808-378-4557
Practice Address - Fax:808-378-4369
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HIMD-20343208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program