Individual
MAVIS A MIZUMOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1268 YOUNG ST, STE 200, HONOLULU, HI 96814-1801
(808) 735-2378
(808) 597-8183
Mailing address
2603 PETER ST, HONOLULU, HI 96816-2013
(808) 735-2378
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-481
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007919184
AETNA
HI
05
—
040501-01
—
HI
01
—
192907
HMN
HI
01
—
C044590-8
HMSA
HI
01
—
PSY481-01
MDX
HI
Enumeration date
01/12/2007
Last updated
01/30/2017
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