Provider Demographics
NPI:1538047402
Name:KAALAKEA, PETA KALEOOKALANI (CHW1)
Entity type:Individual
Prefix:
First Name:PETA
Middle Name:KALEOOKALANI
Last Name:KAALAKEA
Suffix:
Gender:F
Credentials:CHW1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1625
Mailing Address - Country:US
Mailing Address - Phone:702-373-5992
Mailing Address - Fax:725-775-3300
Practice Address - Street 1:4200 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1625
Practice Address - Country:US
Practice Address - Phone:702-373-5992
Practice Address - Fax:725-775-3300
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-6185172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker