Healthcare Provider Details

I. General information

NPI: 1518369131
Provider Name (Legal Business Name): MVP REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1277 KAAHUMANU ST # 106-709
AIEA HI
96701-5314
US

IV. Provider business mailing address

98-1277 KAAHUMANU ST # 106-709
AIEA HI
96701-5314
US

V. Phone/Fax

Practice location:
  • Phone: 808-216-2789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT2267
License Number StateHI

VIII. Authorized Official

Name: KYLE H HIGUCHI
Title or Position: OWNER
Credential:
Phone: 808-261-2789