Healthcare Provider Details

I. General information

NPI: 1487267811
Provider Name (Legal Business Name): SLEEP CENTER HAWAII LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-167 KALANI ST
KAILUA KONA HI
96740-1800
US

IV. Provider business mailing address

75-167 KALANI ST
KAILUA KONA HI
96740-1800
US

V. Phone/Fax

Practice location:
  • Phone: 808-327-6669
  • Fax: 808-327-4506
Mailing address:
  • Phone: 808-327-6669
  • Fax: 808-327-4506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DIVINA MESA
Title or Position: GENERAL MANAGER
Credential:
Phone: 808-456-7378