Provider Demographics
NPI:1336946680
Name:JOUBERT- SOUZA, EVERLEY KAMEKO
Entity type:Individual
Prefix:
First Name:EVERLEY
Middle Name:KAMEKO
Last Name:JOUBERT- SOUZA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:EVERLEY
Other - Middle Name:KAMEKO
Other - Last Name:SOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1931 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-9761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1931 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9761
Practice Address - Country:US
Practice Address - Phone:808-269-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker