Healthcare Provider Details

I. General information

NPI: 1568960177
Provider Name (Legal Business Name): MS. DOVELYN HAUNANI MCKINNON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 E TABOR AVE
FAIRFIELD CA
94533-4104
US

IV. Provider business mailing address

956 E TABOR AVE
FAIRFIELD CA
94533-4104
US

V. Phone/Fax

Practice location:
  • Phone: 707-595-9029
  • Fax: 707-759-3060
Mailing address:
  • Phone: 707-595-9029
  • Fax: 707-759-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: