Healthcare Provider Details

I. General information

NPI: 1174498935
Provider Name (Legal Business Name): SHARAREH FIROUZBAKHT MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76-5914 MAMALAHOA HWY
HOLUALOA HI
96725
US

IV. Provider business mailing address

76-5914 MAMALAHOA HWY
HOLUALOA HI
96725
US

V. Phone/Fax

Practice location:
  • Phone: 832-428-8624
  • Fax:
Mailing address:
  • Phone: 832-428-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHARAREH FIROUZBAKHT
Title or Position: OBGYN
Credential: MD
Phone: 832-428-8624