Healthcare Provider Details

I. General information

NPI: 1700558350
Provider Name (Legal Business Name): MARIA JANELLE BAUTISTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 N SCHOOL ST
HONOLULU HI
96819-2539
US

IV. Provider business mailing address

2019 KAMEHAMEHA IV RD
HONOLULU HI
96819-2634
US

V. Phone/Fax

Practice location:
  • Phone: 808-791-9400
  • Fax:
Mailing address:
  • Phone: 808-675-8599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW-3460
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: