Healthcare Provider Details

I. General information

NPI: 1396336020
Provider Name (Legal Business Name): TAYLOR U'ILAUNA'OLE SANTOS-BALISACAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 LANIHAU PL
HILO HI
96720-5531
US

IV. Provider business mailing address

622 HINANO ST
HILO HI
96720-4427
US

V. Phone/Fax

Practice location:
  • Phone: 808-651-3732
  • Fax:
Mailing address:
  • Phone: 808-969-1935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: