Provider Demographics
NPI:1356113070
Name:REFORMINA, EVON L
Entity type:Individual
Prefix:
First Name:EVON
Middle Name:L
Last Name:REFORMINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160910
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-0921
Mailing Address - Country:US
Mailing Address - Phone:808-389-8696
Mailing Address - Fax:808-451-3765
Practice Address - Street 1:2226 LILIHA ST STE 403
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1605
Practice Address - Country:US
Practice Address - Phone:808-537-1771
Practice Address - Fax:808-451-3765
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter