Healthcare Provider Details

I. General information

NPI: 1063085702
Provider Name (Legal Business Name): SABRINA MOLLEUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-1200 MEHEULA PKWY
MILILANI HI
96789-1748
US

IV. Provider business mailing address

91-1009 KAIPALAOA ST APT 304
EWA BEACH HI
96706-6116
US

V. Phone/Fax

Practice location:
  • Phone: 808-737-3737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: