Healthcare Provider Details

I. General information

NPI: 1427702455
Provider Name (Legal Business Name): BOCHA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 S KIHEI RD
KIHEI HI
96753-5802
US

IV. Provider business mailing address

1140 KAHAAPO LOOP
KIHEI HI
96753-5246
US

V. Phone/Fax

Practice location:
  • Phone: 808-446-2712
  • Fax:
Mailing address:
  • Phone: 808-446-2712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: BEAU LAUGHLIN
Title or Position: OWNER
Credential:
Phone: 808-446-2712