Healthcare Provider Details

I. General information

NPI: 1447752894
Provider Name (Legal Business Name): WARRICK KK KEKAUOHA RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 SALT LAKE BLVD STE D8
HONOLULU HI
96818-3172
US

IV. Provider business mailing address

46-276 KALALI ST
KANEOHE HI
96744-4157
US

V. Phone/Fax

Practice location:
  • Phone: 808-486-1804
  • Fax:
Mailing address:
  • Phone: 808-264-6409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number18-49605
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: