Healthcare Provider Details

I. General information

NPI: 1306769708
Provider Name (Legal Business Name): MHEIDREANA CLAIRE YAGIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 HULI RD
KILAUEA HI
96754-5565
US

IV. Provider business mailing address

91-874 HAHANUI ST
EWA BEACH HI
96706-2831
US

V. Phone/Fax

Practice location:
  • Phone: 808-292-7968
  • Fax:
Mailing address:
  • Phone: 808-369-5147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2835404
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: