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General NPI Number Information
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NPI Number | 1629368311
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Entity Type | Individual
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Provider Name | SANDRA ANN COFFEE LMT
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Gender | Female
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 61-3616 KAWAIHAE RD
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City | KAMUELA
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State | HI
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Zip | 96743-9721
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Country | US
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Telephone | 808-885-6324
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Fax |
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Provider Business Mailing Address
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Address Line | 64-5119 KALAKE ST 64-5119 KALAKE ST
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City | KAMUELA
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State | HI
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Zip | 96743-8201
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Country | US
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Telephone | 808-885-6324
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Fax | 808-885-6324
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MAT5246
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License Number State | HI
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