Individual
MALIA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 S BERETANIA ST STE 102, HONOLULU, HI 96814-1871
(808) 356-5699
Mailing address
2324 KAALA ST, HONOLULU, HI 96822-2201
(702) 501-1848
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
AMD1425
HI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/04/2018
Last updated
03/05/2026
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