=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699471599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SATORI MENTAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2023
-----------------------------------------------------
Last Update Date | 02/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5972 HEAMOI PL
-----------------------------------------------------
City | KAPAA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96746-9704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-722-7710
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5972 HEAMOI PL
-----------------------------------------------------
City | KAPAA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96746-9704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-722-7710
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP-BC, OWNER
-----------------------------------------------------
Name | MARQUITA ANN GRANDA
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 808-722-7710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------