Healthcare Provider Details

I. General information

NPI: 1851848931
Provider Name (Legal Business Name): NOELANI MARITA VARGAS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65-1230 MAMALAHOA HWY STE E11
KAMUELA HI
96743-7301
US

IV. Provider business mailing address

PO BOX 2821
KAMUELA HI
96743-2821
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-7131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-4252
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: