Healthcare Provider Details

I. General information

NPI: 1245898022
Provider Name (Legal Business Name): MRS. VALEEN VICTORIA VILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N VINEYARD BLVD STE 600
HONOLULU HI
96817-3952
US

IV. Provider business mailing address

6750 HAWAII KAI DR APT 306
HONOLULU HI
96825-1521
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-8188
  • Fax: 808-524-1021
Mailing address:
  • Phone: 808-953-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: