Basic Information
| Provider Information | |||||||||
| NPI: | 1467128785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAURER | ||||||||
| FirstName: | NICOLAS | ||||||||
| MiddleName: | YUJI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2436 PUUNUI AVE | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968171337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082023355 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4510 SALT LAKE BLVD STE D8 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968183172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084861804 | ||||||||
| FaxNumber: | 8084869199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2021 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 106S00000X | BACB711377 | HI | Y |
ID Information
| ID | Type | State | Issuer | Description | XLER000022675706 | 01 | HI | HMSA | OTHER |