Healthcare Provider Details

I. General information

NPI: 1093387037
Provider Name (Legal Business Name): MISS OLIVIA NICOLE DEMARCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 COLBURN ST
HONOLULU HI
96819-3248
US

IV. Provider business mailing address

99-870 IWAENA ST
AIEA HI
96701-3278
US

V. Phone/Fax

Practice location:
  • Phone: 808-845-0102
  • Fax:
Mailing address:
  • Phone: 808-277-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: