Provider Demographics
NPI:1528257847
Name:CORREA, SIMONE KARLA (LMT)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:KARLA
Last Name:CORREA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 ANAPUNI ST
Mailing Address - Street 2:#103
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3279
Mailing Address - Country:US
Mailing Address - Phone:808-232-3772
Mailing Address - Fax:
Practice Address - Street 1:1314 S KING ST
Practice Address - Street 2:#1516
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1956
Practice Address - Country:US
Practice Address - Phone:808-591-9339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 8854171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor