Healthcare Provider Details

I. General information

NPI: 1154592772
Provider Name (Legal Business Name): SLEEP CENTER HAWAII LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2008
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-128 AIEA HEIGHTS DR STE 101
AIEA HI
96701-3916
US

IV. Provider business mailing address

99-128 AIEA HEIGHTS DR STE 101
AIEA HI
96701-3916
US

V. Phone/Fax

Practice location:
  • Phone: 808-456-7378
  • Fax: 808-483-8822
Mailing address:
  • Phone: 808-456-7378
  • Fax: 808-483-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberMD13641
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD13641
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD13641
License Number StateHI

VIII. Authorized Official

Name: DIVINA MESA
Title or Position: GENERAL MANAGER
Credential: RPSGT
Phone: 671-647-6669