Healthcare Provider Details

I. General information

NPI: 1316749633
Provider Name (Legal Business Name): CAMILLE S MANDINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5919 WALUA RD
KAILUA KONA HI
96740-1375
US

IV. Provider business mailing address

P.O. BOX 1231
KEALAKEKUA HI
96750
US

V. Phone/Fax

Practice location:
  • Phone: 928-208-6909
  • Fax:
Mailing address:
  • Phone: 808-339-4792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: