Healthcare Provider Details

I. General information

NPI: 1962119131
Provider Name (Legal Business Name): MAYA WALDREP RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 PEPEEKEO ST
HONOLULU HI
96825-1119
US

IV. Provider business mailing address

2705 KAIMUKI AVE
HONOLULU HI
96816-1312
US

V. Phone/Fax

Practice location:
  • Phone: 808-397-5822
  • Fax:
Mailing address:
  • Phone:
  • 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: