Provider Demographics
NPI:1154100840
Name:MUJAKIC, MATILDA
Entity type:Individual
Prefix:
First Name:MATILDA
Middle Name:
Last Name:MUJAKIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MATILDA
Other - Middle Name:
Other - Last Name:PEREZ DE LEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:203 KAPAA QUARRY PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:808-741-2232
Mailing Address - Fax:
Practice Address - Street 1:1419 KOKEA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2887
Practice Address - Country:US
Practice Address - Phone:315-350-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician