Provider Demographics
NPI:1194871269
Name:JOHNSON, ROMA J L (AUD)
Entity type:Individual
Prefix:
First Name:ROMA
Middle Name:J L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-184 HUALALAI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1719
Mailing Address - Country:US
Mailing Address - Phone:808-334-4400
Mailing Address - Fax:
Practice Address - Street 1:75-184 HUALALAI RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1719
Practice Address - Country:US
Practice Address - Phone:808-334-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAUD-54231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49511003Medicaid
HI0000255414OtherHMSA BILLING NUMBER
HI0000255414OtherHMSA BILLING NUMBER
HIQ54044Medicare UPIN