Healthcare Provider Details

I. General information

NPI: 1811343510
Provider Name (Legal Business Name): DR JESSICA BARRETO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5526 KEALIA ST
HOLUALOA HI
96725-9613
US

IV. Provider business mailing address

75-5526 KEALIA ST
HOLUALOA HI
96725-9613
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-6997
  • Fax: 808-329-6987
Mailing address:
  • Phone: 808-329-6997
  • Fax: 808-329-6987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC1336
License Number StateHI

VIII. Authorized Official

Name: DR. JESSICA BARRETO
Title or Position: OWNER
Credential: DC
Phone: 808-329-6997