Provider Demographics
NPI:1811642523
Name:STUMFALL, LUKE
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:STUMFALL
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 1:223 HALENANI DR
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2404
Mailing Address - Country:US
Mailing Address - Phone:818-231-4213
Mailing Address - Fax:
Practice Address - Street 1:2125 KAHEKILI HWY
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-9208
Practice Address - Country:US
Practice Address - Phone:808-727-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH01702009OtherDRIVER'S LICENSE