Healthcare Provider Details

I. General information

NPI: 1992429377
Provider Name (Legal Business Name): SHERENE HAJIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 PEPEEKEO PL
HONOLULU HI
96825-1113
US

IV. Provider business mailing address

588 PEPEEKEO PL
HONOLULU HI
96825-1113
US

V. Phone/Fax

Practice location:
  • Phone: 808-953-7200
  • Fax:
Mailing address:
  • Phone: 808-953-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-453
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: