Provider Demographics
NPI:1124062377
Name:ORIMOTO, LISA NOBUKO (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:NOBUKO
Last Name:ORIMOTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:NOBUKO
Other - Last Name:DEAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 724
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-0724
Mailing Address - Country:US
Mailing Address - Phone:808-484-8901
Mailing Address - Fax:
Practice Address - Street 1:98-211 PALI MOMI ST
Practice Address - Street 2:SUITE 635
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4301
Practice Address - Country:US
Practice Address - Phone:808-554-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI629103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPSY 629-02OtherMDX
HI087988Medicaid