Healthcare Provider Details

I. General information

NPI: 1588294623
Provider Name (Legal Business Name): RACHEL C BOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S BERETANIA ST # 300
HONOLULU HI
96813-5703
US

IV. Provider business mailing address

95-273 WAIKALANI DR APT D1002
MILILANI HI
96789-3524
US

V. Phone/Fax

Practice location:
  • Phone: 808-380-5183
  • Fax:
Mailing address:
  • Phone: 973-634-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberAT-253
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: