Healthcare Provider Details

I. General information

NPI: 1467970640
Provider Name (Legal Business Name): MAJA TEOHAREVIC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-1249 MEHEULA PKWY STE 187
MILILANI HI
96789-1791
US

IV. Provider business mailing address

95-1249 MEHEULA PKWY STE 187
MILILANI HI
96789-1791
US

V. Phone/Fax

Practice location:
  • Phone: 808-625-6444
  • Fax: 808-623-2552
Mailing address:
  • Phone: 808-625-6444
  • Fax: 808-623-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: