Healthcare Provider Details

I. General information

NPI: 1750691481
Provider Name (Legal Business Name): ANNIE BERNADETTE ANDERSON DR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-782 WIKAO STREET N-201
MILILANI HI
96789-5089
US

IV. Provider business mailing address

6121B HERON AVE
EWA BEACH HI
96706-3341
US

V. Phone/Fax

Practice location:
  • Phone: 714-702-9577
  • Fax:
Mailing address:
  • Phone: 808-489-2486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: