Provider Demographics
NPI:1023644523
Name:OKAMOTO, ROXAN MAE SARDIDO
Entity type:Individual
Prefix:
First Name:ROXAN MAE
Middle Name:SARDIDO
Last Name:OKAMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ROXAN MAE
Other - Middle Name:YUZON
Other - Last Name:SARDIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1178 LUNAHANA PLACE
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:808-799-0922
Mailing Address - Fax:808-600-5813
Practice Address - Street 1:1178 LUNAHANA PLACE
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-799-0922
Practice Address - Fax:808-600-5813
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist