Healthcare Provider Details

I. General information

NPI: 1326641440
Provider Name (Legal Business Name): SIERRA GAUTHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 KALANIANAOLE HWY # 5001
KAILUA HI
96734-4645
US

IV. Provider business mailing address

520 LUNALILO HOME RD UNIT 6119
HONOLULU HI
96825-1749
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2973
  • Fax:
Mailing address:
  • Phone: 480-489-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: