Healthcare Provider Details

I. General information

NPI: 1174039424
Provider Name (Legal Business Name): DANALYNNE LLACUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 12/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 SALT LAKE BLVD STE D8
HONOLULU HI
96818-3172
US

IV. Provider business mailing address

92-1212 PALAHIA ST APT W106
KAPOLEI HI
96707-2339
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: