Provider Demographics
NPI:1316295918
Name:FONOIMOANA, CARL MALELE JR
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:MALELE
Last Name:FONOIMOANA
Suffix:JR
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 1:55-533 IOSEPA STREET
Mailing Address - Street 2:
Mailing Address - City:LAIE
Mailing Address - State:HI
Mailing Address - Zip Code:96762
Mailing Address - Country:US
Mailing Address - Phone:808-224-3423
Mailing Address - Fax:
Practice Address - Street 1:55-533 IOSEPA STREET
Practice Address - Street 2:
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762
Practice Address - Country:US
Practice Address - Phone:808-224-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health