Healthcare Provider Details

I. General information

NPI: 1457999724
Provider Name (Legal Business Name): KATLIN CILLIERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1221 KA UKA BLVD
WAIPAHU HI
96797-6202
US

IV. Provider business mailing address

2452 TUSITALA ST APT 1204
HONOLULU HI
96815-3126
US

V. Phone/Fax

Practice location:
  • Phone: 808-773-2792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-108183
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: