Healthcare Provider Details

I. General information

NPI: 1043925985
Provider Name (Legal Business Name): STEFANIA ANN XYTAKIS HEALTH COACH, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 ALA MAKANI ST STE 200
KAHULUI HI
96732-3571
US

IV. Provider business mailing address

PO BOX 2636
WAILUKU HI
96793-7636
US

V. Phone/Fax

Practice location:
  • Phone: 808-204-2893
  • Fax:
Mailing address:
  • Phone: 808-250-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberN1204704
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: