Healthcare Provider Details

I. General information

NPI: 1285342865
Provider Name (Legal Business Name): SEAN LUZ EYMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-450 MOKUOLA ST
WAIPAHU HI
96797-3388
US

IV. Provider business mailing address

94-033 KUAHELANI AVE APT 111
MILILANI HI
96789-1774
US

V. Phone/Fax

Practice location:
  • Phone: 808-944-2882
  • Fax:
Mailing address:
  • Phone: 808-852-0922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-160262
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: