Healthcare Provider Details

I. General information

NPI: 1679089445
Provider Name (Legal Business Name): MAKELA SOLOMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-955 KAMEHAMEHA HWY
KANEOHE HI
96744-3222
US

IV. Provider business mailing address

55-530 MOANA ST
LAIE HI
96762-1233
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-41650
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: