Healthcare Provider Details

I. General information

NPI: 1831779966
Provider Name (Legal Business Name): BRANDON ABELLA MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LANAKILA AVE
HONOLULU HI
96817-2115
US

IV. Provider business mailing address

91-1058 HOOMALIU ST
KAPOLEI HI
96707-2787
US

V. Phone/Fax

Practice location:
  • Phone: 808-724-4362
  • Fax:
Mailing address:
  • Phone: 808-366-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-2337
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: