| Metamorphosis, Llc | |
|
50 Calasa Rd Kula HI 96790-8101 | |
| (808) 783-4404 | |
| Not Available |
| Full Name | Metamorphosis, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 50 Calasa Rd, Kula, Hawaii |
| Authorized Official Name and Position | Ilana Alaneo Fernandez (OWNER) |
| Authorized Official Contact | 8087834404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Metamorphosis, Llc Po Box 784 Kula HI 96790-0784 Ph: (808) 783-4404 | Metamorphosis, Llc 50 Calasa Rd Kula HI 96790-8101 Ph: (808) 783-4404 |
| NPI Number | 1548520091 |
|---|---|
| Provider Enumeration Date | 05/17/2012 |
| Last Update Date | 03/07/2014 |
| Medicare PECOS PAC ID | 3577726124 |
|---|---|
| Medicare Enrollment ID | O20120518000458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548520091 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | PSY - 959 (Hawaii) | Primary |
| Provider Name | Ilana A Fernandez |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1538283551 PECOS PAC ID: 0547423196 Enrollment ID: I20120518000493 |
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