Healthcare Provider Details

I. General information

NPI: 1407553324
Provider Name (Legal Business Name): JONATHAN HALEYESEMAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 KAPA'A QUARRY PL
KAILUA HI
96734
US

IV. Provider business mailing address

2333 KAPIOLANI BLVD APT 2517
HONOLULU HI
96826-4456
US

V. Phone/Fax

Practice location:
  • Phone: 808-741-2232
  • Fax:
Mailing address:
  • Phone:
  • 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: