Healthcare Provider Details

I. General information

NPI: 1689593584
Provider Name (Legal Business Name): MELIA KIMIE NIINO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-3524 IWIKUAMOO ST UNIT 702
EWA BEACH HI
96706-5893
US

IV. Provider business mailing address

91-733A ONEULA PL
EWA BEACH HI
96706-2511
US

V. Phone/Fax

Practice location:
  • Phone: 808-520-4633
  • Fax:
Mailing address:
  • Phone: 808-520-4633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1559423
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: