Healthcare Provider Details

I. General information

NPI: 1518231059
Provider Name (Legal Business Name): MIRELLA VASQUEZ BROOKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1005 MOANALUA RD SUITE 420
AIEA HI
96701-4777
US

IV. Provider business mailing address

98-1005 MOANALUA RD SUITE 420
AIEA HI
96701-4777
US

V. Phone/Fax

Practice location:
  • Phone: 808-440-4836
  • Fax: 808-440-4827
Mailing address:
  • Phone: 808-440-4836
  • Fax: 808-440-4827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN253
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: