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General NPI Number Information
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NPI Number | 1366253791
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Entity Type | Individual
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Provider Name | DESIREE MINA
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Gender | Female
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 4510 SALT LAKE BLVD STE D8
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City | HONOLULU
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State | HI
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Zip | 96818-3172
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Country | US
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Telephone | 808-486-2804
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 90
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City | WAIALUA
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State | HI
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Zip | 96791-0090
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Country | US
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Telephone | 808-450-4312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB1249598
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License Number State | HI
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