Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1093249492 |
---|---|
Provider Name | Shaela Sakamoto |
First Address | Haiku, HI 96708-0804 |
Second Address | Las Vegas, NV 89183-6293 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2017 |
Last Update Date | 12/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XLEH652273 | (05) | HI |