Provider Demographics
NPI:1487717146
Name:MATSUOKA, JOAN T (RN, MN,CFM)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:T
Last Name:MATSUOKA
Suffix:
Gender:F
Credentials:RN, MN,CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 MANOA RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1226
Mailing Address - Country:US
Mailing Address - Phone:808-988-8004
Mailing Address - Fax:808-536-2931
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 706
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-988-8004
Practice Address - Fax:808-536-2931
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI201391OtherHEALTH MANAGEMENT ASSOC.
HIZ1627OtherQUEEN'S HEALTH CARE PLAN
HI07246701Medicaid
HI9422-7OtherHAWAII MED. SERV. ASSOC.
HI0287800001Medicare ID - Type Unspecified