MEDICARE: DOMINIQUE TIMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1174475933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE TIMES

Provider Business Mailing Address
First Line	:	100 KAHELU AVE STE 110
Second Line	:
City	:	MILILANI
State	:	HI
Zip	:	96789-3913
Country	:	US
Telephone Number	:	808-625-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 E LIPOA ST STE 29
Second Line	:
City	:	KIHEI
State	:	HI
Zip	:	96753-8148
Country	:	US
Telephone Number	:	808-625-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ DOMINIQUE TIMES ” Practice Location

Language	Start Address	Practice Location

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