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General NPI Number Information
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NPI Number | 1841142189
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Entity Type | Organization
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Legal Business Name | EARTHLY BALANCE MENTAL WELLNESS
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 200 N VINEYARD BLVD STE A325-439
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City | HONOLULU
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State | HI
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Zip | 96817-3950
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Country | US
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Telephone | 808-646-3782
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Fax | 808-336-2112
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Provider Business Mailing Address
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Address Line | 200 N VINEYARD BLVD STE A325-439
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City | HONOLULU
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State | HI
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Zip | 96817-3950
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Country | US
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Telephone | 808-646-3782
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Fax | 808-336-2112
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Authorized Official
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Title or Position | OWNER
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Name | MEMPHIS CHARDELL SANDOVAL
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Credential | PMHNP-BC
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Telephone | 808-646-3782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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