12D0724063 CLIA NUMBER - PUKALANI FAMILY PRACTICE, LLC

Laboratory Demographics

  • CLIA Code: 12D0724063
  • Facility Name: PUKALANI FAMILY PRACTICE, LLC
  • Facility Address: 81 MAKAWAO AVE, STE 100
    MAKAWAO, HI
    ZIP 96768
  • Facility Phone: 808 573-8900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERT MASTROIANNI
  • NPI Number: 1063009207
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 12D0724063
LAB Type Physician Office
Facility Name PUKALANI FAMILY PRACTICE, LLC
Street 81 MAKAWAO AVE, STE 100
City MAKAWAO
State HI
ZIP 96768
Phone 808 573-8900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2023
Certificate Expiration Date 12/26/2025
Facility Type Physician Office
Lab Director ROBERT MASTROIANNI

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This page was last updated on: 9/29/2025