Healthcare Provider Details

I. General information

NPI: 1881108652
Provider Name (Legal Business Name): MILESTONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 MILILANI ST STE 400
HONOLULU HI
96813-2934
US

IV. Provider business mailing address

820 MILILANI ST STE 400
HONOLULU HI
96813-2934
US

V. Phone/Fax

Practice location:
  • Phone: 808-979-6700
  • Fax: 808-441-9875
Mailing address:
  • Phone: 808-979-6700
  • Fax: 808-441-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IRISA DEVINE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 808-979-6700