Healthcare Provider Details

I. General information

NPI: 1063909281
Provider Name (Legal Business Name): MS. TIFFANI SAKIKO MAHINA OBAYASHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67-383 KUKEA CIR
WAIALUA HI
96791-9520
US

IV. Provider business mailing address

67-383 KUKEA CIR
WAIALUA HI
96791-9520
US

V. Phone/Fax

Practice location:
  • Phone: 808-520-7183
  • Fax:
Mailing address:
  • Phone: 808-520-7183
  • 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: