Healthcare Provider Details

I. General information

NPI: 1558282871
Provider Name (Legal Business Name): SARA MYLEE RICO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E LIPOA ST STE 29
KIHEI HI
96753-8148
US

IV. Provider business mailing address

100 KAHELU AVE STE 110
MILILANI HI
96789-3913
US

V. Phone/Fax

Practice location:
  • Phone: 808-646-0641
  • Fax:
Mailing address:
  • Phone: 808-646-0641
  • 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: