Healthcare Provider Details

I. General information

NPI: 1104332477
Provider Name (Legal Business Name): TIANA SOARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HEKILI ST STE A406
KAILUA HI
96734-2800
US

IV. Provider business mailing address

25 KANEOHE BAY DR UNIT 211212
KAILUA HI
96734-1727
US

V. Phone/Fax

Practice location:
  • Phone: 808-489-3548
  • Fax: 808-443-0708
Mailing address:
  • Phone: 808-388-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69665
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-10366
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: